| NPI | 1699753624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MA 3134) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CT 1082) |
| 152WC0802X Optometrist, Corneal and Contact Management (Licence: MA 3134) | |
| Enumeration Date | 2006-01-09 |
| Last Update Date | 2007-07-08 |