NPI | 1427041615 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: MO 2007030935) |
Additional Taxonomies | 152W00000X Optometrist (Licence: TN 1778) |
Enumeration Date | 2005-08-24 |
Last Update Date | 2020-06-10 |