| NPI | 1699835272 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MA MA3812-T) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: MA 3812) |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2025-02-03 |