| NPI | 1578182192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MA 5404) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: RI ODTG00700) |
| Enumeration Date | 2020-04-14 |
| Last Update Date | 2025-09-11 |