| NPI | 1972529360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IA 076578) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CT 3437) |
| 152W00000X Optometrist (Licence: CO 0004010) | |
| 152W00000X Optometrist (Licence: SC 2586) | |
| 152W00000X Optometrist (Licence: OH 007460) | |
| Enumeration Date | 2006-07-15 |
| Last Update Date | 2026-05-05 |