NPI | 1538654470 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: ID 100653) |
Additional Taxonomies | 152W00000X Optometrist (Licence: AZ OPT-002255) |
Enumeration Date | 2018-06-23 |
Last Update Date | 2024-07-12 |