| NPI | 1376161703 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: SC 2208) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MD TA3062) |
| Enumeration Date | 2020-07-13 |
| Last Update Date | 2025-04-07 |