| NPI | 1780909770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MA 4780) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: RI ODTG00545) |
| Enumeration Date | 2010-04-01 |
| Last Update Date | 2013-03-21 |