| NPI | 1386709947 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MA OPT5082) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: RI ODTGA00591) |
| Enumeration Date | 2006-12-26 |
| Last Update Date | 2026-03-24 |