NPI | 1104488634 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: DE I3-0001427) |
Additional Taxonomies | 152W00000X Optometrist (Licence: PA OEG003540) |
Enumeration Date | 2019-07-04 |
Last Update Date | 2020-10-18 |