| NPI | 1285745604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NH 0728) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MA 4207) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2016-01-04 |