NPI | 1679269948 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: MO 2023020565) |
Additional Taxonomies | 152W00000X Optometrist (Licence: KS 2191) |
Enumeration Date | 2023-04-11 |
Last Update Date | 2024-04-30 |