| NPI | 1366554081 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CT 002676) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MA 4523) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2018-05-16 |