| NPI | 1033269790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: VA 0618000786) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MD DA0790) |
| Enumeration Date | 2007-01-12 |
| Last Update Date | 2012-01-14 |