| NPI | 1710328943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MD TA2657) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MD DA2657) |
| Enumeration Date | 2013-07-16 |
| Last Update Date | 2021-01-07 |