NPI | 1306495031 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: MD TA2752) |
Additional Taxonomies | 152W00000X Optometrist (Licence: TX 9844) |
Enumeration Date | 2019-09-05 |
Last Update Date | 2020-09-29 |