| NPI | 1609861129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: GA OPT 002577) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: FL TPOP165) |
| 152W00000X Optometrist (Licence: MO 2022041049) | |
| 152W00000X Optometrist (Licence: TX 10731T) | |
| 152W00000X Optometrist (Licence: UT 12955090-9934) | |
| 152W00000X Optometrist (Licence: MD TA2978) | |
| 152W00000X Optometrist (Licence: NY 009924) | |
| Enumeration Date | 2005-09-12 |
| Last Update Date | 2024-01-09 |