| NPI | 1851388292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MA 3874) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: RI ODTA00459) |
| Enumeration Date | 2005-09-30 |
| Last Update Date | 2018-01-02 |