NPI | 1124352687 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: MI 4901004537) |
Additional Taxonomies | 152W00000X Optometrist (Licence: IN 18003669A) |
Enumeration Date | 2009-09-30 |
Last Update Date | 2022-01-12 |