| NPI | 1235353384 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MD TA-2249) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: PR 645) |
| Enumeration Date | 2007-04-12 |
| Last Update Date | 2023-07-02 |