| NPI | 1235174889 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: ME OPT832TA6) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: ME 832TA) |
| Enumeration Date | 2006-06-18 |
| Last Update Date | 2011-01-04 |