| NPI | 1336619550 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: RI ODTG00680) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NH 0984) |
| 152W00000X Optometrist (Licence: MA OPT5349) | |
| Enumeration Date | 2018-11-30 |
| Last Update Date | 2024-03-19 |