| NPI | 1770109738 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AK 222789) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MD TA2734) |
| Enumeration Date | 2020-06-24 |
| Last Update Date | 2024-09-25 |