| NPI | 1750379087 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY VUT4433) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: VA 0618002616) |
| 152W00000X Optometrist (Licence: WI 21447-875) | |
| 152W00000X Optometrist (Licence: MI 4901005040) | |
| 152W00000X Optometrist (Licence: CO OPT.0003325) | |
| 152W00000X Optometrist (Licence: CT 3016) | |
| 152W00000X Optometrist (Licence: MN 3500) | |
| 152W00000X Optometrist (Licence: FL TPOP61) | |
| 152W00000X Optometrist (Licence: MD DA2597) | |
| Enumeration Date | 2005-10-11 |
| Last Update Date | 2023-02-17 |