| NPI | 1306272406 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: ME OPT949) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MN 3398) |
| Enumeration Date | 2013-09-20 |
| Last Update Date | 2015-08-20 |