| NPI | 1164839601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152WP0200X Optometrist, Pediatrics (Licence: DC MTL002518) |
| Additional Taxonomies | 152WP0200X Optometrist, Pediatrics (Licence: VA 0116026982) |
| 152WP0200X Optometrist, Pediatrics (Licence: MD P29964) | |
| Enumeration Date | 2014-07-16 |
| Last Update Date | 2014-07-16 |