| NPI | 1306942024 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: VT 320) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NH 0761) |
| 152W00000X Optometrist (Licence: OK 2419) | |
| Enumeration Date | 2006-09-16 |
| Last Update Date | 2007-07-08 |