| NPI | 1730136979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: VA 0618000581) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MD TA0609) |
| Enumeration Date | 2006-05-30 |
| Last Update Date | 2008-08-01 |