| NPI | 1225037393 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OH 4642 T1417) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IN 18003492A) |
| 152W00000X Optometrist (Licence: PA OEG002019) | |
| 152W00000X Optometrist (Licence: MI L1374544) | |
| 152W00000X Optometrist (Licence: NY TUV007663-1) | |
| 152W00000X Optometrist (Licence: NJ 27OA00629300) | |
| Enumeration Date | 2005-07-20 |
| Last Update Date | 2020-06-18 |