| NPI | 1841638756 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: VA 0618002246) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MD TA2351) |
| Enumeration Date | 2013-06-13 |
| Last Update Date | 2018-01-23 |