| NPI | 1396896338 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: VA 0618001118) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: DC OP633) |
| 152W00000X Optometrist (Licence: MD TA1063m) | |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2007-07-08 |