NPI | 1033294111 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPC4668) |
Additional Taxonomies | 152W00000X Optometrist (Licence: NY 5255) |
152W00000X Optometrist (Licence: NJ 5155) | |
Enumeration Date | 2006-10-26 |
Last Update Date | 2019-12-04 |