NPI | 1588951990 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: CO 0003046) |
Additional Taxonomies | 152W00000X Optometrist (Licence: VA 0618002042) |
152W00000X Optometrist (Licence: IN 18003694A) | |
Enumeration Date | 2011-07-06 |
Last Update Date | 2024-09-05 |