NPI | 1578557757 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: VA 0618001024) |
Additional Taxonomies | 152W00000X Optometrist (Licence: NC 1777) |
152W00000X Optometrist (Licence: TN 2031) | |
Enumeration Date | 2005-09-02 |
Last Update Date | 2023-01-17 |