NPI | 1316388218 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: CO OPT.0003668) |
Additional Taxonomies | 152W00000X Optometrist (Licence: PA OEG002822) |
152W00000X Optometrist (Licence: OK 2829) | |
Enumeration Date | 2013-07-09 |
Last Update Date | 2021-07-14 |