| NPI | 1740571520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NC 2258) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CT 2831) |
| Enumeration Date | 2011-04-27 |
| Last Update Date | 2013-02-13 |