| NPI | 1447222336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MD TA0599) |
| Additional Taxonomies | 152WS0006X Optometrist, Sports Vision (Licence: MD TAO599) |
| Enumeration Date | 2006-02-03 |
| Last Update Date | 2019-12-23 |