| NPI | 1073878476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MD TA2316) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: VA 0618002162) |
| Enumeration Date | 2012-07-11 |
| Last Update Date | 2024-05-04 |