| NPI | 1780653378 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CT 933) |
| Additional Taxonomies | 152WL0500X Optometrist Low Vision Rehabilitation (Licence: CT 933) |
| Enumeration Date | 2006-03-16 |
| Last Update Date | 2020-07-06 |