NPI | 1417148255 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 152W00000X Optometrist (Licence: VA 0618001684) |
Additional Taxonomies | 152W00000X Optometrist (Licence: FL OPC4303) |
152W00000X Optometrist (Licence: NY 009756) | |
Enumeration Date | 2007-08-07 |
Last Update Date | 2024-08-23 |