| NPI | 1639458979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CO 3299) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CA 14218 TLG) |
| 152W00000X Optometrist (Licence: NM 0650) | |
| 152W00000X Optometrist (Licence: WI 3991-35) | |
| 152W00000X Optometrist (Licence: FL TPOP46) | |
| 152W00000X Optometrist (Licence: VT 030.0133998TELE) | |
| Enumeration Date | 2011-08-04 |
| Last Update Date | 2024-07-30 |