| NPI | 1356963391 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NE 1561) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: VT 030.0133922-EMGY) |
| Enumeration Date | 2020-05-13 |
| Last Update Date | 2024-04-04 |