| NPI | 1508845025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NH 0768) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: VT 030.000331) |
| Enumeration Date | 2006-01-12 |
| Last Update Date | 2019-09-10 |