| NPI | 1255614392 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: RI ODTG000571) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: PA OEG002548) |
| Enumeration Date | 2011-09-26 |
| Last Update Date | 2020-01-06 |