| NPI | 1972608974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TX 10889T) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: FL TPOP25) |
| 152W00000X Optometrist (Licence: NC 1349) | |
| 152W00000X Optometrist (Licence: IA 105592) | |
| 152W00000X Optometrist (Licence: NY TUV009264) | |
| 152W00000X Optometrist (Licence: TN ODT1296) | |
| 152W00000X Optometrist (Licence: MN 3663) | |
| 152W00000X Optometrist (Licence: CO OPT.0003453) | |
| 152W00000X Optometrist (Licence: VT 030.0133915) | |
| 152W00000X Optometrist (Licence: VA 0618002847) | |
| 152W00000X Optometrist (Licence: WI 21391-875) | |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2023-11-06 |