| NPI | 1598850208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MD TA 1721) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: VA 0618001017) |
| 152W00000X Optometrist (Licence: DC OP1000059) | |
| 152W00000X Optometrist (Licence: NY TUV006190-1) | |
| 152W00000X Optometrist (Licence: MD TA1721) | |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2024-07-09 |