| NPI | 1740700913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NH 1052) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: VT 030.0131034) |
| Enumeration Date | 2017-06-20 |
| Last Update Date | 2022-03-11 |