NPI | 1053864488 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: ME OPT982) |
Additional Taxonomies | 152W00000X Optometrist (Licence: MA 5202) |
Enumeration Date | 2016-08-02 |
Last Update Date | 2017-11-14 |