| NPI | 1982916458 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: DE I3-0001372) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NJ 27OA00632100) |
| 152W00000X Optometrist (Licence: DE I4-0000072) | |
| 152W00000X Optometrist (Licence: OH 5930) | |
| Enumeration Date | 2010-07-13 |
| Last Update Date | 2015-04-15 |