| NPI | 1285693598 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MD TA2546) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: FL 4014) |
| Enumeration Date | 2006-03-23 |
| Last Update Date | 2019-07-12 |