| NPI | 1619031960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: VA 0618000171) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: DC OP423) |
| Enumeration Date | 2006-12-21 |
| Last Update Date | 2021-06-02 |