| NPI | 1942516562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: VA 0618001995) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MD TA2207) |
| Enumeration Date | 2010-08-19 |
| Last Update Date | 2012-12-02 |