NPI | 1124247101 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: MD TA0953) |
Additional Taxonomies | 152W00000X Optometrist (Licence: VA 0618003166) |
Enumeration Date | 2007-04-25 |
Last Update Date | 2024-01-26 |