| NPI | 1780738401 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPC2702) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MI 4901003666) |
| 152W00000X Optometrist (Licence: OH 4503 T1172) | |
| 152W00000X Optometrist (Licence: HI 569) | |
| 152W00000X Optometrist (Licence: IN 18003143A) | |
| 152W00000X Optometrist (Licence: CO 1716) | |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2024-06-21 |