| NPI | 1760465769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152WX0102X Optometrist, Occupational Vision (Licence: MD TAO782) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MD TAO782) |
| Enumeration Date | 2005-11-22 |
| Last Update Date | 2025-09-11 |