| NPI | 1891363644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152WP0200X Optometrist Pediatrics (Licence: MA OPT5604) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MA OPT5604) |
| 152W00000X Optometrist (Licence: OH OPT.006985) | |
| Enumeration Date | 2021-06-16 |
| Last Update Date | 2023-12-06 |