| NPI | 1376547851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: RI ODTA00508) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MA 4390) |
| Enumeration Date | 2005-06-13 |
| Last Update Date | 2024-10-15 |