NPI | 1396125183 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 152W00000X Optometrist (Licence: NC 2453) |
Additional Taxonomies | 152WP0200X Optometrist, Pediatrics (Licence: CA OPT15457 TLG) |
152W00000X Optometrist (Licence: OH OPT6361) | |
Enumeration Date | 2015-06-05 |
Last Update Date | 2023-07-11 |