| NPI | 1811948193 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: RI ODTG00555) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: RI ODTA00348) |
| 152W00000X Optometrist (Licence: MA 2975) | |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2024-02-15 |