| NPI | 1902992886 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152WP0200X Optometrist, Pediatrics (Licence: MA 3407) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MA 3407) |
| 152WV0400X Optometrist, Vision Therapy (Licence: MA 3407) | |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2014-05-19 |