| NPI | 1528041415 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MD TA2707) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MD R241160) |
| Enumeration Date | 2005-11-23 |
| Last Update Date | 2020-10-20 |