| NPI | 1699089201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MD TA2203) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: VA 0618001936) |
| Enumeration Date | 2010-08-06 |
| Last Update Date | 2011-08-17 |