| NPI | 1881756476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: DE I3-0011439) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MD DA1451) |
| 152W00000X Optometrist (Licence: VA 0618000301) | |
| Enumeration Date | 2006-12-14 |
| Last Update Date | 2023-01-31 |