NPI | 1295746840 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: ID ODP-100217) |
Additional Taxonomies | 152W00000X Optometrist (Licence: GA 1869) |
Enumeration Date | 2006-08-10 |
Last Update Date | 2019-05-13 |