| NPI | 1932152147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: RI ODTG00465) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MA 3170) |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2023-06-26 |