| NPI | 1457316259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MA 003306) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: RI 407) |
| Enumeration Date | 2006-04-18 |
| Last Update Date | 2010-08-11 |