NPI | 1093914087 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPC4359) |
Additional Taxonomies | 152W00000X Optometrist (Licence: PA OEG001922) |
Enumeration Date | 2007-07-11 |
Last Update Date | 2018-10-18 |