| NPI | 1295720423 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: DC OP1000432) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: VA 0618000427) |
| Enumeration Date | 2005-09-14 |
| Last Update Date | 2023-11-03 |