| NPI | 1225055759 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: RI ODTG00492) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MA 4190) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2007-07-08 |