| NPI | 1518025410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152WP0200X Optometrist, Pediatrics (Licence: MD D45187) |
| Additional Taxonomies | 152WP0200X Optometrist, Pediatrics (Licence: VA 0101042637) |
| 152WP0200X Optometrist, Pediatrics (Licence: DC MD17409) | |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2007-07-08 |