| NPI | 1205886736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NE 998) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: VA 0601800388) |
| 152W00000X Optometrist (Licence: IA 15201890) | |
| 152W00000X Optometrist (Licence: CO 2277) | |
| 152W00000X Optometrist (Licence: OR 2967T) | |
| 152W00000X Optometrist (Licence: WA OD00003880) | |
| 152W00000X Optometrist (Licence: UT 5659180-9934) | |
| 152W00000X Optometrist (Licence: LA 1387) | |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2015-04-30 |