| NPI | 1376507376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA 7372T) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: FL 1507) |
| 152W00000X Optometrist (Licence: KS 1142) | |
| 152W00000X Optometrist (Licence: MO T02407) | |
| 152W00000X Optometrist (Licence: OK 2085) | |
| 152W00000X Optometrist (Licence: TX 2652T) | |
| 152W00000X Optometrist (Licence: WA 2001TX) | |
| 152W00000X Optometrist (Licence: WV 711-OD) | |
| Enumeration Date | 2006-04-14 |
| Last Update Date | 2007-07-08 |