| NPI | 1659447548 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MD TA2232) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: DC OP1000042) |
| Enumeration Date | 2006-11-24 |
| Last Update Date | 2018-01-31 |