NPI | 1649848235 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 152W00000X Optometrist (Licence: TN OD3686) |
Additional Taxonomies | 152W00000X Optometrist (Licence: VA 0618003018) |
Enumeration Date | 2021-06-11 |
Last Update Date | 2023-06-02 |