| NPI | 1043288145 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MD TA1483) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: VA 0618000801) |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2022-03-31 |