NPI | 1114278447 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: ID ODP-100254) |
Additional Taxonomies | 152W00000X Optometrist (Licence: MA 4943) |
Enumeration Date | 2012-09-26 |
Last Update Date | 2021-07-23 |