| NPI | 1952494833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPC3539) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: LA 1240395T) |
| 152W00000X Optometrist (Licence: PA 0E7371P) | |
| 152W00000X Optometrist (Licence: TN 1148) | |
| 152W00000X Optometrist (Licence: VA 0601001915) | |
| 152W00000X Optometrist (Licence: WA 2013) | |
| 152W00000X Optometrist (Licence: AL R134TA518) | |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2017-01-24 |