| NPI | 1285293100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MD TA2676) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: VA 0618003161) |
| 207W00000X Ophthalmology (Licence: VA 0618003161) | |
| Enumeration Date | 2019-06-13 |
| Last Update Date | 2022-11-02 |