| NPI | 1154980209 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MA 5694) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CT 3287) |
| 152WP0200X Optometrist, Pediatrics (Licence: VA 0618002770) | |
| Enumeration Date | 2019-06-12 |
| Last Update Date | 2025-07-29 |