| NPI | 1245379924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NH 334) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MA 2643) |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2015-03-27 |