| NPI | 1487681284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: DE I3-0001136) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MD TA0661) |
| 152W00000X Optometrist (Licence: PA OE004862P) | |
| Enumeration Date | 2006-06-27 |
| Last Update Date | 2017-01-26 |