NPI | 1649603572 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: UT 9488924-9934) |
Additional Taxonomies | 152W00000X Optometrist (Licence: IL 046010703) |
Enumeration Date | 2013-08-14 |
Last Update Date | 2016-06-29 |