| NPI | 1396838314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: LA 939165T) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: KY 2316DT) |
| 152W00000X Optometrist (Licence: MD DA2924) | |
| 152W00000X Optometrist (Licence: SC 1395) | |
| 152W00000X Optometrist (Licence: DE I5-0000002) | |
| 152W00000X Optometrist (Licence: PA OET009163) | |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2023-10-06 |