NPI | 1578978201 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 152W00000X Optometrist (Licence: MD TA2485) |
Additional Taxonomies | 152W00000X Optometrist (Licence: PA OEG002929) |
Enumeration Date | 2014-06-20 |
Last Update Date | 2023-05-10 |