| NPI | 1326216896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AK 147608) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NM 527) |
| 152W00000X Optometrist (Licence: UT 5384255-9934) | |
| 152W00000X Optometrist (Licence: WA OD60276287) | |
| Enumeration Date | 2008-02-18 |
| Last Update Date | 2021-10-02 |