| NPI | 1215969035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MD TA0624) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: VA 0618001126) |
| 152W00000X Optometrist (Licence: DC OP726) | |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2007-10-25 |