| NPI | 1275845026 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MD TA2330) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OH 5957 / T2891) |
| 152W00000X Optometrist (Licence: VA 0618002175) | |
| Enumeration Date | 2010-07-09 |
| Last Update Date | 2024-02-13 |