| NPI | 1346301033 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MA 3007) |
| Additional Taxonomies | 152WL0500X Optometrist Low Vision Rehabilitation (Licence: MA 3007) |
| 152WP0200X Optometrist Pediatrics (Licence: MA 3007) | |
| 152WV0400X Optometrist Vision Therapy (Licence: MA 3007) | |
| Enumeration Date | 2006-12-13 |
| Last Update Date | 2007-07-08 |