| NPI | 1275810079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MT OPT-OPT-LIC-3096) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: UT 9885098-9934) |
| 152W00000X Optometrist (Licence: OR 3437ATI) | |
| 152W00000X Optometrist (Licence: ID ODP-100231) | |
| Enumeration Date | 2011-11-08 |
| Last Update Date | 2020-03-25 |