NPI | 1306907860 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPC2180) |
Additional Taxonomies | 152W00000X Optometrist (Licence: GA 001713) |
Enumeration Date | 2006-12-12 |
Last Update Date | 2022-05-06 |