| NPI | 1932264579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MA 1732) |
| Additional Taxonomies | 156FX1800X Technician/Technologist, Optician (Licence: MA 1732) |
| Enumeration Date | 2006-12-26 |
| Last Update Date | 2007-07-08 |