| NPI | 1043725476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MD TA2617) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: RI odtg00652) |
| 152W00000X Optometrist (Licence: VA 0618002739) | |
| Enumeration Date | 2017-12-07 |
| Last Update Date | 2023-09-13 |