| NPI | 1891170494 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MD TA2570) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: VA 0618002469) |
| 152W00000X Optometrist (Licence: DC OP1000320) | |
| Enumeration Date | 2015-07-23 |
| Last Update Date | 2022-04-04 |