| NPI | 1487212346 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CT 3134) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MA 5348) |
| Enumeration Date | 2019-06-04 |
| Last Update Date | 2022-03-28 |