NPI | 1629578836 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: NV 1006) |
Additional Taxonomies | 152W00000X Optometrist (Licence: CA 33887TLG) |
Enumeration Date | 2018-02-14 |
Last Update Date | 2019-02-10 |