| NPI | 1184801268 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TX 6879 T) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NV 895) |
| 152W00000X Optometrist (Licence: LA 1215-386T) | |
| 152W00000X Optometrist (Licence: TN 3331) | |
| 152W00000X Optometrist (Licence: IN 18004006A) | |
| 152W00000X Optometrist (Licence: NY TUV008541-1) | |
| Enumeration Date | 2008-01-30 |
| Last Update Date | 2018-04-11 |