| NPI | 1093892812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: DE 13-0001314) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MD TA0753) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2024-09-12 |