NPI | 1093261646 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: AZ 2197) |
Additional Taxonomies | 152W00000X Optometrist (Licence: OK 2878) |
Enumeration Date | 2016-09-01 |
Last Update Date | 2018-11-05 |