| NPI | 1699742429 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CT 939) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MA 2893) |
| Enumeration Date | 2006-03-01 |
| Last Update Date | 2007-09-10 |