NPI | 1194138123 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: IA 073225) |
Additional Taxonomies | 152W00000X Optometrist (Licence: IL 046010786) |
Enumeration Date | 2014-06-06 |
Last Update Date | 2021-12-08 |