NPI | 1609427418 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: MN 3772) |
Additional Taxonomies | 152W00000X Optometrist (Licence: IN 18004196A) |
Enumeration Date | 2019-09-23 |
Last Update Date | 2022-05-18 |