NPI | 1639646664 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: MN 3655) |
Additional Taxonomies | 152W00000X Optometrist (Licence: NJ 27OA00684100) |
Enumeration Date | 2018-10-29 |
Last Update Date | 2019-09-23 |