NPI | 1326454869 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: NE 1424) |
Additional Taxonomies | 152W00000X Optometrist (Licence: IA 074096) |
Enumeration Date | 2014-07-04 |
Last Update Date | 2017-05-08 |