| NPI | 1194728188 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY TUV004544) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CO OPT.0003908) |
| 152W00000X Optometrist (Licence: MT OPT-OPT-LIC-4597) | |
| 152W00000X Optometrist (Licence: VA 0618003176) | |
| Enumeration Date | 2005-05-24 |
| Last Update Date | 2023-05-04 |