NPI | 1265969109 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: OH OPT.006705) |
Additional Taxonomies | 152W00000X Optometrist (Licence: FL OPC5402) |
Enumeration Date | 2017-05-22 |
Last Update Date | 2019-06-18 |