NPI | 1730110537 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 152W00000X Optometrist (Licence: SC 1218) |
Additional Taxonomies | 152W00000X Optometrist (Licence: SC 01218) |
Enumeration Date | 2006-07-06 |
Last Update Date | 2022-12-21 |