| NPI | 1497880512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MD TA2294) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: FL opc3506) |
| 152W00000X Optometrist (Licence: VA 0618002102) | |
| Enumeration Date | 2007-02-22 |
| Last Update Date | 2012-09-27 |