| NPI | 1912696311 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MD TA2999) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: DE I3-0011467) |
| Enumeration Date | 2023-05-02 |
| Last Update Date | 2024-06-05 |