NPI | 1366064503 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: NV 1113) |
Additional Taxonomies | 152W00000X Optometrist (Licence: CA 34598) |
152W00000X Optometrist (Licence: AZ 2498) | |
Enumeration Date | 2020-05-11 |
Last Update Date | 2024-01-24 |