| NPI | 1831171206 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: ME 836TA) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NH 0698) |
| Enumeration Date | 2005-11-18 |
| Last Update Date | 2016-04-25 |