| NPI | 1093712580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: RI ODTG000498) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: RI ODTG00498) |
| Enumeration Date | 2005-06-30 |
| Last Update Date | 2014-05-13 |