NPI | 1639306053 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: SC 1669) |
Additional Taxonomies | 152W00000X Optometrist (Licence: KY 1813dt) |
Enumeration Date | 2009-06-11 |
Last Update Date | 2020-10-22 |