NPI | 1518232149 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 152W00000X Optometrist (Licence: MN 3415) |
Additional Taxonomies | 152W00000X Optometrist (Licence: VT 0000000) |
Enumeration Date | 2012-03-15 |
Last Update Date | 2018-04-10 |