NPI | 1609989995 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 152W00000X Optometrist (Licence: OH 4229) |
Additional Taxonomies | 152W00000X Optometrist (Licence: GU 35) |
152W00000X Optometrist (Licence: CO 1659) | |
Enumeration Date | 2006-08-17 |
Last Update Date | 2022-07-21 |