NPI | 1154463099 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: NM OPT589) |
Additional Taxonomies | 152W00000X Optometrist (Licence: ID ODP-100001) |
152W00000X Optometrist (Licence: OR ATI2539) | |
152W00000X Optometrist (Licence: WA OD00001864) | |
152W00000X Optometrist (Licence: MT OPT-OPT-LIC-2803) | |
Enumeration Date | 2007-02-13 |
Last Update Date | 2020-11-12 |