NPI | 1730118878 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: IN 18003828A) |
Additional Taxonomies | 152W00000X Optometrist (Licence: MI MI4901003146) |
Enumeration Date | 2006-07-01 |
Last Update Date | 2021-04-12 |