| NPI | 1831202076 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: PA OEG000849) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NJ 27OA00709800) |
| 152W00000X Optometrist (Licence: GA OPT003290) | |
| 152W00000X Optometrist (Licence: MO 2020006059) | |
| 152W00000X Optometrist (Licence: FL TPOP20) | |
| 152W00000X Optometrist (Licence: IL 046011484) | |
| 152W00000X Optometrist (Licence: MD TA2729) | |
| Enumeration Date | 2006-08-15 |
| Last Update Date | 2024-02-05 |