NPI | 1518016716 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: IL 046-008290) |
Additional Taxonomies | 152W00000X Optometrist (Licence: WI 2326-35) |
152W00000X Optometrist (Licence: FL TPOP31) | |
Enumeration Date | 2007-01-09 |
Last Update Date | 2023-07-19 |