NPI | 1447870258 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: NE 1533) |
Additional Taxonomies | 152W00000X Optometrist (Licence: IA 099902) |
Enumeration Date | 2020-04-22 |
Last Update Date | 2021-09-27 |