| NPI | 1366197782 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MA 5544) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CT 003319) |
| Enumeration Date | 2022-02-14 |
| Last Update Date | 2023-12-01 |