| NPI | 1275796229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: WV 3047-IOD) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MD TA2095) |
| Enumeration Date | 2008-07-09 |
| Last Update Date | 2025-01-09 |