| NPI | 1538169784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: RI ODTA-00491) |
| Additional Taxonomies | 152WP0200X Optometrist, Pediatrics (Licence: RI ODTA-00491) |
| Enumeration Date | 2005-07-29 |
| Last Update Date | 2013-04-16 |