NPI | 1437247038 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 152W00000X Optometrist (Licence: MN 1629) |
Additional Taxonomies | 152W00000X Optometrist (Licence: MN MN1629) |
Enumeration Date | 2006-10-10 |
Last Update Date | 2022-09-02 |