| NPI | 1134216112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: VA 0618001702) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MD TA2040) |
| 152W00000X Optometrist (Licence: TX 9112T) | |
| Enumeration Date | 2006-10-09 |
| Last Update Date | 2026-08-10 |