| NPI | 1023114279 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MD TA1797) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: DC OP1000280) |
| Enumeration Date | 2006-09-15 |
| Last Update Date | 2021-12-17 |