NPI | 1306083787 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 152W00000X Optometrist (Licence: FL 004330) |
Additional Taxonomies | 152W00000X Optometrist (Licence: NC 2116) |
Enumeration Date | 2009-01-07 |
Last Update Date | 2021-04-13 |