NPI | 1588673677 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: MO 2005022668) |
Additional Taxonomies | 152W00000X Optometrist (Licence: CO 1778) |
152W00000X Optometrist (Licence: NE 1132) | |
Enumeration Date | 2006-08-06 |
Last Update Date | 2022-02-11 |