| NPI | 1861457814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CT 002540) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NH 1009) |
| Enumeration Date | 2006-04-20 |
| Last Update Date | 2022-07-21 |