NPI | 1275845026 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: MD TA2330) |
Additional Taxonomies | 152W00000X Optometrist (Licence: OH 5957 / T2891) |
152W00000X Optometrist (Licence: VA 0618002175) | |
Enumeration Date | 2010-07-09 |
Last Update Date | 2024-02-13 |