NPI | 1013291566 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPC4665) |
Additional Taxonomies | 152W00000X Optometrist (Licence: PA OEG002557) |
152W00000X Optometrist (Licence: NY TUV007963) | |
Enumeration Date | 2011-10-03 |
Last Update Date | 2016-09-27 |