| NPI | 1124474317 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: RI ODTG00628) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: RI applied for) |
| Enumeration Date | 2016-05-06 |
| Last Update Date | 2023-02-28 |