| NPI | 1972943173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MD TA2360) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: DC OPT1000277) |
| 152W00000X Optometrist (Licence: VA 0618002256) | |
| Enumeration Date | 2013-07-02 |
| Last Update Date | 2024-04-29 |