| NPI | 1891752259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: VA 0618001208) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MD TA1354) |
| Enumeration Date | 2006-04-28 |
| Last Update Date | 2026-05-15 |