| NPI | 1245301746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IN 18003561A) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CO OPT-2544) |
| 152W00000X Optometrist (Licence: KY 1833DT) | |
| 152W00000X Optometrist (Licence: LA 1595-628T) | |
| 152W00000X Optometrist (Licence: OH 5992) | |
| 152W00000X Optometrist (Licence: TX 8142T) | |
| Enumeration Date | 2006-11-13 |
| Last Update Date | 2014-06-10 |