NPI | 1104018746 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: WV 2064) |
Additional Taxonomies | 152W00000X Optometrist (Licence: VA 0618001648) |
Enumeration Date | 2007-08-17 |
Last Update Date | 2023-11-03 |