| NPI | 1477113025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: RI ODTG00707) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: WI 3562-35) |
| Enumeration Date | 2019-06-17 |
| Last Update Date | 2022-11-03 |