NPI | 1295964724 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: MN 3277) |
Additional Taxonomies | 152W00000X Optometrist (Licence: IL 046010262) |
Enumeration Date | 2009-07-06 |
Last Update Date | 2022-09-02 |