| NPI | 1790754901 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CT 002297) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CT 02297) |
| Enumeration Date | 2006-03-17 |
| Last Update Date | 2020-03-11 |