| NPI | 1154375418 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: RI ODTG00416) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MA 3465) |
| Enumeration Date | 2006-05-20 |
| Last Update Date | 2015-01-16 |