| NPI | 1447402821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: RI ODTG00529) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MA 4874) |
| Enumeration Date | 2008-10-16 |
| Last Update Date | 2014-04-03 |