| NPI | 1336136894 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MA 3839) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: RI ODTG00461) |
| Enumeration Date | 2005-09-30 |
| Last Update Date | 2023-07-13 |