NPI | 1689057366 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPC5084) |
Additional Taxonomies | 152W00000X Optometrist (Licence: AL R-298-TA-C19) |
Enumeration Date | 2015-06-30 |
Last Update Date | 2023-05-15 |