| NPI | 1366557738 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY TUV007355) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: WI 3702-35) |
| 152W00000X Optometrist (Licence: IL 346002045) | |
| 152W00000X Optometrist (Licence: FL TPOP68) | |
| 152W00000X Optometrist (Licence: IA 105426) | |
| 152W00000X Optometrist (Licence: VA 0618002935) | |
| Enumeration Date | 2006-08-19 |
| Last Update Date | 2023-03-06 |