| NPI | 1073694980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OR AT4542) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CA OPT 13359T) |
| 152W00000X Optometrist (Licence: NJ 27OA00605800) | |
| 152W00000X Optometrist (Licence: NY TUV 007065) | |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2021-03-24 |