| NPI | 1730122938 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: VA 0618001565) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MD TA1956) |
| 152W00000X Optometrist (Licence: DC OP1000103) | |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2007-07-08 |