NPI | 1689853533 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 152W00000X Optometrist (Licence: AR 2604) |
Additional Taxonomies | 152W00000X Optometrist (Licence: OK 2565) |
152W00000X Optometrist (Licence: TN 2749) | |
Enumeration Date | 2007-10-29 |
Last Update Date | 2020-09-29 |