| NPI | 1912911470 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MD TA1094) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: DC OP668) |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2007-07-08 |