| NPI | 1457303729 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MA 3864) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CT 002385) |
| 152W00000X Optometrist (Licence: MA 4563) | |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2022-01-21 |