NPI | 1164562682 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: CT 3231) |
Additional Taxonomies | 152W00000X Optometrist (Licence: PA 0EG001877) |
152W00000X Optometrist (Licence: NY 007216) | |
152W00000X Optometrist (Licence: SC 1812) | |
Enumeration Date | 2007-02-07 |
Last Update Date | 2022-08-31 |