| NPI | 1962016998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MD TA2773) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: VA 0618002982) |
| Enumeration Date | 2020-09-08 |
| Last Update Date | 2023-05-12 |