| NPI | 1770268583 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MA OPT8317) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: RI ODTG00775) |
| Enumeration Date | 2023-06-19 |
| Last Update Date | 2025-08-12 |