| NPI | 1750386835 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MA 2736) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NH 0450) |
| Enumeration Date | 2005-06-16 |
| Last Update Date | 2015-03-24 |