| NPI | 1881360196 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: VA 06180003280) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: PA OEG003803) |
| 152W00000X Optometrist (Licence: DC OP2000529) | |
| 152W00000X Optometrist (Licence: MD TA2887) | |
| Enumeration Date | 2021-08-17 |
| Last Update Date | 2024-02-18 |