| NPI | 1467486852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NH 726) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MA 3796) |
| 152WC0802X Optometrist, Corneal and Contact Management (Licence: NH 726) | |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2013-06-13 |