NPI | 1134170905 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 152W00000X Optometrist (Licence: OR 2681 ATI) |
Additional Taxonomies | 332H00000X Eyewear Supplier (Equipment, not the service) |
Enumeration Date | 2006-05-15 |
Last Update Date | 2020-03-01 |