NPI | 1366422545 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 152W00000X Optometrist (Licence: SC 1987) |
Additional Taxonomies | 152W00000X Optometrist (Licence: TN 1984) |
Enumeration Date | 2006-01-23 |
Last Update Date | 2023-11-17 |