| NPI | 1932289782 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: VA 0618001548) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MD TA2001) |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2019-02-26 |