| NPI | 1902031578 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MD TA2142) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MD pending) |
| Enumeration Date | 2009-05-26 |
| Last Update Date | 2018-01-30 |