| NPI | 1467448613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: VT 0300000333) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NH 0770) |
| Enumeration Date | 2005-09-23 |
| Last Update Date | 2016-08-08 |