NPI | 1710671565 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: NV 1164) |
Additional Taxonomies | 152W00000X Optometrist (Licence: NY ORT010014) |
Enumeration Date | 2023-06-05 |
Last Update Date | 2024-09-12 |