| NPI | 1740206846 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MD TA0593) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: DC OP342) |
| 152W00000X Optometrist (Licence: PA OE004333T) | |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2015-05-12 |