| NPI | 1396992145 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: VA 0618001741) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MD TA2098) |
| Enumeration Date | 2008-08-23 |
| Last Update Date | 2013-10-16 |