| NPI | 1851720429 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MD TA2391) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MO 2013032691) |
| Enumeration Date | 2013-11-05 |
| Last Update Date | 2013-11-05 |