| NPI | 1487143657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: RI odtg00689) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MA 5279) |
| Enumeration Date | 2018-05-03 |
| Last Update Date | 2021-12-20 |