| NPI | 1982664116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: KY 2091DT) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: UT 10241269-9934) |
| 152W00000X Optometrist (Licence: WV 0936-IOD) | |
| 152W00000X Optometrist (Licence: OH OPT.006517) | |
| Enumeration Date | 2006-03-23 |
| Last Update Date | 2023-06-27 |