| NPI | 1609322320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: VA 0618002592) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IL 046011051) |
| 152W00000X Optometrist (Licence: DC OP1000363) | |
| 152W00000X Optometrist (Licence: MD TA2580) | |
| Enumeration Date | 2016-09-01 |
| Last Update Date | 2021-09-09 |