| NPI | 1154364800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MD TA0917) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: VA 0618001710) |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2021-12-10 |