| NPI | 1821023839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: WV 843OD) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: FL 843-IODf) |
| 152W00000X Optometrist (Licence: MD DA2907) | |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2023-06-19 |