NPI | 1033457494 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 152W00000X Optometrist (Licence: UT 8706878-9934) |
Additional Taxonomies | 152W00000X Optometrist (Licence: NV NV 759) |
Enumeration Date | 2013-01-19 |
Last Update Date | 2021-01-05 |