| NPI | 1912107905 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AZ OPT-002563) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MD TA2750) |
| 152W00000X Optometrist (Licence: MN 3669) | |
| 152W00000X Optometrist (Licence: MO 2020030535) | |
| 152W00000X Optometrist (Licence: NY TUV007204) | |
| 152W00000X Optometrist (Licence: NJ 27OA00611900) | |
| 152W00000X Optometrist (Licence: VA 0618002846) | |
| 152WC0802X Optometrist, Corneal and Contact Management (Licence: PA OEG001972) | |
| 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: PA OEG001972) | |
| 152WX0102X Optometrist, Occupational Vision (Licence: PA OEG001972) | |
| 152W00000X Optometrist (Licence: PA OEG001972) | |
| 152W00000X Optometrist (Licence: FL TPOP24) | |
| 152W00000X Optometrist (Licence: GA OPT003403) | |
| 152W00000X Optometrist (Licence: IL 046011388) | |
| Enumeration Date | 2007-07-19 |
| Last Update Date | 2023-05-05 |