NPI | 1255397329 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: MN 2759) |
Additional Taxonomies | 152W00000X Optometrist (Licence: OH 4725) |
152W00000X Optometrist (Licence: OH T1529) | |
152W00000X Optometrist (Licence: TN 1777) | |
Enumeration Date | 2006-04-26 |
Last Update Date | 2020-05-04 |