| NPI | 1346344082 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MA 3985) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TN 2500) |
| Enumeration Date | 2006-09-12 |
| Last Update Date | 2007-07-08 |