NPI | 1013064385 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: IL 046010945) |
Additional Taxonomies | 156FX1800X Technician/Technologist, Optician (Licence: CT 001322) |
152W00000X Optometrist (Licence: CT 3.002790) | |
Enumeration Date | 2007-01-05 |
Last Update Date | 2016-12-09 |