| NPI | 1386620789 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NH 552) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: VT 0300000272) |
| Enumeration Date | 2005-12-16 |
| Last Update Date | 2024-01-23 |