| NPI | 1639111271 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: RI OD00499) |
| Additional Taxonomies | 332H00000X Eyewear Supplier (Equipment, not the service) (Licence: RI OD00499) |
| Enumeration Date | 2006-06-11 |
| Last Update Date | 2008-03-31 |