| NPI | 1720077076 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NH 922) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: VA 0618001016) |
| Enumeration Date | 2005-10-19 |
| Last Update Date | 2017-02-19 |