| NPI | 1285158162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CT 3063) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: ME OPT985) |
| Enumeration Date | 2017-08-01 |
| Last Update Date | 2022-07-21 |