NPI | 1588942569 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: MI 4901004793) |
Additional Taxonomies | 152W00000X Optometrist (Licence: PA OEG002510) |
152W00000X Optometrist (Licence: ME OPT930) | |
Enumeration Date | 2011-07-25 |
Last Update Date | 2016-11-30 |