| NPI | 1417260894 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: VA 0618001961) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: DC OP1000199) |
| Enumeration Date | 2010-07-14 |
| Last Update Date | 2018-01-25 |