| NPI | 1811084403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: RI ODTA00349) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: RI ODT00349) |
| Enumeration Date | 2006-10-06 |
| Last Update Date | 2010-05-26 |