| NPI | 1184685729 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MA MA2745) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MA 2745) |
| Enumeration Date | 2006-03-31 |
| Last Update Date | 2018-07-17 |