NPI | 1356725535 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: WA 60636872) |
Additional Taxonomies | 152W00000X Optometrist (Licence: NY TUV008336) |
Enumeration Date | 2015-07-16 |
Last Update Date | 2017-05-01 |