| NPI | 1205106648 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MD TA2257) |
| Additional Taxonomies | 152WP0200X Optometrist, Pediatrics (Licence: MD TA2257) |
| Enumeration Date | 2012-01-02 |
| Last Update Date | 2024-12-09 |