NPI | 1518930064 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: CO 2778) |
Additional Taxonomies | 152W00000X Optometrist (Licence: OH 5232) |
152W00000X Optometrist (Licence: OH T2136) | |
Enumeration Date | 2006-02-07 |
Last Update Date | 2021-06-14 |