| NPI | 1962816421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MD TA2410) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: DC OP1000296) |
| 152W00000X Optometrist (Licence: VA 0618002351) | |
| Enumeration Date | 2014-06-12 |
| Last Update Date | 2016-03-09 |