NPI | 1124113162 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 152W00000X Optometrist (Licence: SC 1935) |
Additional Taxonomies | 152W00000X Optometrist (Licence: AL R-339) |
152W00000X Optometrist (Licence: GA OPT003370) | |
Enumeration Date | 2006-10-04 |
Last Update Date | 2024-05-03 |