| NPI | 1669912283 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152WP0200X Optometrist Pediatrics (Licence: MA 5201) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MA 5201) |
| Enumeration Date | 2017-03-01 |
| Last Update Date | 2020-04-22 |