| NPI | 1538412044 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: RI 00588) |
| Additional Taxonomies | 152WC0802X Optometrist Corneal and Contact Management (Licence: RI 00588) |
| Enumeration Date | 2012-10-22 |
| Last Update Date | 2023-10-04 |