NPI | 1093892812 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: DE 13-0001314) |
Additional Taxonomies | 152W00000X Optometrist (Licence: MD TA0753) |
Enumeration Date | 2006-11-01 |
Last Update Date | 2024-09-12 |