| NPI | 1346327301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: DE I30001211OS) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: DE G000697PA) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2020-08-13 |