NPI | 1285366310 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 152W00000X Optometrist (Licence: MO 2022022991) |
Additional Taxonomies | 152W00000X Optometrist (Licence: IL 046.011788) |
Enumeration Date | 2022-06-28 |
Last Update Date | 2024-03-22 |