| NPI | 1558472878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: VA 0618001068) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MD TA 1661) |
| 152W00000X Optometrist (Licence: DC OP1000039) | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2014-06-21 |