| NPI | 1780065813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MA 5097) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: RI ODTG00613) |
| Enumeration Date | 2015-06-15 |
| Last Update Date | 2020-03-11 |