| NPI | 1003905639 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: DC OP717) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NE 1194) |
| 152W00000X Optometrist (Licence: NY 006055) | |
| 152W00000X Optometrist (Licence: AL R138) | |
| 152W00000X Optometrist (Licence: MD TA1200) | |
| 152W00000X Optometrist (Licence: CO 2359) | |
| 152W00000X Optometrist (Licence: PA OE008140P) | |
| 152W00000X Optometrist (Licence: MN 2793) | |
| 152W00000X Optometrist (Licence: MI 4901004174) | |
| 152W00000X Optometrist (Licence: MO 2005001747) | |
| 152W00000X Optometrist (Licence: SC 1142) | |
| 152W00000X Optometrist (Licence: ID ODP1047) | |
| 152W00000X Optometrist (Licence: IN 18003267A) | |
| 152W00000X Optometrist (Licence: WI 2967035) | |
| 152W00000X Optometrist (Licence: IA 02213) | |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2007-07-08 |