| NPI | 1497063622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MD TA2281) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: VA 0618002097) |
| Enumeration Date | 2010-09-22 |
| Last Update Date | 2015-09-28 |