NPI | 1235369844 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: PA OEG002211) |
Additional Taxonomies | 152W00000X Optometrist (Licence: IN 18003576A) |
152W00000X Optometrist (Licence: OH OPT.5850-THER) | |
Enumeration Date | 2009-07-16 |
Last Update Date | 2016-03-08 |