| NPI | 1841755212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TX 9631TG) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: VA 0618003190) |
| 152W00000X Optometrist (Licence: NE 1616) | |
| 152W00000X Optometrist (Licence: PA OET009161) | |
| 152W00000X Optometrist (Licence: WA OD00001453) | |
| 152W00000X Optometrist (Licence: AZ 002667) | |
| 152W00000X Optometrist (Licence: IA 116656) | |
| 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: TX 9631TG) | |
| Enumeration Date | 2019-02-09 |
| Last Update Date | 2023-07-24 |