| NPI | 1083238471 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: VA 0618003014) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MD TA2744) |
| Enumeration Date | 2020-06-02 |
| Last Update Date | 2021-07-01 |