| NPI | 1578647715 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MD TA0889) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: VA 0618000551) |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2022-04-25 |