| NPI | 1003102757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MD TA2283) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: UT 7999538-9934) |
| 152W00000X Optometrist (Licence: DC OP1000233) | |
| 152W00000X Optometrist (Licence: VA 0618002098) | |
| 152W00000X Optometrist (Licence: CO OPT0002942) | |
| 152W00000X Optometrist (Licence: IL 046010522) | |
| Enumeration Date | 2011-06-21 |
| Last Update Date | 2013-07-29 |