| NPI | 1174554562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MD TA0785) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: VA 0618001431) |
| 152W00000X Optometrist (Licence: DC OP483) | |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2018-01-29 |