NPI | 1568431047 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: TX 7506TG) |
Additional Taxonomies | 152W00000X Optometrist (Licence: MO 2000161497) |
152W00000X Optometrist (Licence: IL 046006567) | |
Enumeration Date | 2006-03-16 |
Last Update Date | 2021-05-27 |