NPI | 1245342898 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 152W00000X Optometrist (Licence: LA 1383-519T) |
Additional Taxonomies | 152W00000X Optometrist (Licence: TX 6684TG) |
Enumeration Date | 2006-08-31 |
Last Update Date | 2022-07-21 |