| NPI | 1184613259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CT 0823) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MA 2525) |
| 152W00000X Optometrist (Licence: NH 330) | |
| Enumeration Date | 2005-10-20 |
| Last Update Date | 2007-07-08 |