NPI | 1275810079 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: MT OPT-OPT-LIC-3096) |
Additional Taxonomies | 152W00000X Optometrist (Licence: UT 9885098-9934) |
152W00000X Optometrist (Licence: OR 3437ATI) | |
152W00000X Optometrist (Licence: ID ODP-100231) | |
Enumeration Date | 2011-11-08 |
Last Update Date | 2020-03-25 |