NPI | 1568690774 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: CO OPT.0003092) |
Additional Taxonomies | 152W00000X Optometrist (Licence: VA 0618001861) |
Enumeration Date | 2009-06-25 |
Last Update Date | 2024-04-11 |