| NPI | 1043226178 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OR 3022ATI) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MD TA1285) |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2008-11-05 |