| NPI | 1023660701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: DE I3-0001420) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MD TA2675) |
| Enumeration Date | 2019-07-12 |
| Last Update Date | 2021-11-19 |