NPI | 1386909729 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPC4973) |
Additional Taxonomies | 152W00000X Optometrist (Licence: MD TA2342) |
152W00000X Optometrist (Licence: MI 4901004719) | |
Enumeration Date | 2012-07-11 |
Last Update Date | 2019-04-29 |