| NPI | 1558845396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MD TA2648) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: DC OP1000389) |
| 152W00000X Optometrist (Licence: VA 0618002687) | |
| Enumeration Date | 2018-09-18 |
| Last Update Date | 2018-09-18 |