| NPI | 1538238787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MA 3947) |
| Additional Taxonomies | 152WC0802X Optometrist Corneal and Contact Management (Licence: MA 3947) |
| Enumeration Date | 2006-11-06 |
| Last Update Date | 2007-07-08 |