| NPI | 1093950693 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AZ 1635) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MT OPT-OPT-LIC-2800) |
| 152W00000X Optometrist (Licence: UT 100836529934) | |
| 152W00000X Optometrist (Licence: CT 003006) | |
| 152W00000X Optometrist (Licence: WA 60696160) | |
| 152W00000X Optometrist (Licence: VA 0618002534) | |
| 152W00000X Optometrist (Licence: CO opt0003259) | |
| 152W00000X Optometrist (Licence: ID odp-100384) | |
| 152W00000X Optometrist (Licence: OR 4066at) | |
| 152W00000X Optometrist (Licence: WI 3591-35) | |
| 152W00000X Optometrist (Licence: IN 18004200A) | |
| 152W00000X Optometrist (Licence: OH OPT.0003259) | |
| Enumeration Date | 2008-12-10 |
| Last Update Date | 2020-04-13 |