| NPI | 1124247101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MD TA0953) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: VA 0618003166) |
| Enumeration Date | 2007-04-25 |
| Last Update Date | 2024-01-26 |