| NPI | 1093950834 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA 13659) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MN 3987) |
| 152W00000X Optometrist (Licence: NY 011128) | |
| 152W00000X Optometrist (Licence: WI 4068-35) | |
| 152W00000X Optometrist (Licence: WV 2030IOD) | |
| Enumeration Date | 2008-12-09 |
| Last Update Date | 2025-12-16 |