| NPI | 1285288506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MD TA2685) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: WV 2073) |
| 152W00000X Optometrist (Licence: VA 0618003046) | |
| Enumeration Date | 2019-07-25 |
| Last Update Date | 2023-03-29 |