| NPI | 1528001278 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 152W00000X Optometrist (Licence: VA 0618001113) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MD TA1631) |
| 152W00000X Optometrist (Licence: DC OP823) | |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2007-07-08 |