| NPI | 1508953225 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MD TA 1912) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: DC OP1000012) |
| Enumeration Date | 2006-10-06 |
| Last Update Date | 2015-09-23 |