| NPI | 1740393156 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NH 0776) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MA 2577) |
| 152WC0802X Optometrist, Corneal and Contact Management (Licence: NH 0776) | |
| 152WC0802X Optometrist, Corneal and Contact Management (Licence: MA 2577) | |
| 152WX0102X Optometrist, Occupational Vision (Licence: NH 0776) | |
| 152WX0102X Optometrist, Occupational Vision (Licence: MA 2577) | |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2008-05-09 |