| NPI | 1548378532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NH 0696) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: VT 0300000299) |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2011-03-31 |