| NPI | 1811900806 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NC 1820) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NH 0537) |
| 152W00000X Optometrist (Licence: VT 0300000256) | |
| Enumeration Date | 2006-08-14 |
| Last Update Date | 2008-10-23 |