NPI | 1437508587 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 152W00000X Optometrist (Licence: IL 046011016) |
Additional Taxonomies | 152W00000X Optometrist (Licence: WA OD60643254) |
Enumeration Date | 2016-06-09 |
Last Update Date | 2016-06-11 |