| NPI | 1619028115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: ME OPT656) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: ME OPT656) |
| Enumeration Date | 2007-01-13 |
| Last Update Date | 2019-01-11 |