| NPI | 1356385272 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MA 4065) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CT 002465) |
| 152W00000X Optometrist (Licence: NH 0847) | |
| 152W00000X Optometrist (Licence: NY TUV005854-1) | |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2015-07-15 |