| NPI | 1265069876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MD TA2785) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: WV 2076-IOD) |
| Enumeration Date | 2020-03-24 |
| Last Update Date | 2023-11-03 |