| NPI | 1043487143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: GA 1895) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY 006248) |
| 152W00000X Optometrist (Licence: CA 11832) | |
| 152W00000X Optometrist (Licence: NJ 27OA00601800) | |
| 152W00000X Optometrist (Licence: CT 002704) | |
| Enumeration Date | 2008-05-08 |
| Last Update Date | 2013-08-02 |