NPI | 1104915990 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: MN 2705) |
Additional Taxonomies | 152W00000X Optometrist (Licence: ND 570) |
Enumeration Date | 2006-10-12 |
Last Update Date | 2022-06-29 |