NPI | 1255337549 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: UT 5354587-8904) |
Additional Taxonomies | 152W00000X Optometrist (Licence: UT 5354587-9934) |
Enumeration Date | 2005-06-22 |
Last Update Date | 2023-03-07 |