NPI | 1619265543 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: NV 965) |
Additional Taxonomies | 152W00000X Optometrist (Licence: PA OEG002524) |
Enumeration Date | 2011-07-12 |
Last Update Date | 2022-07-11 |