| NPI | 1669485199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: VA 0618000627) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: DC OP1000265) |
| 152W00000X Optometrist (Licence: FL TPOP123) | |
| 152W00000X Optometrist (Licence: NE 1566) | |
| 152W00000X Optometrist (Licence: WI 3737-35) | |
| Enumeration Date | 2006-08-14 |
| Last Update Date | 2023-03-06 |