NPI | 1770868820 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: IA 074027) |
Additional Taxonomies | 152W00000X Optometrist (Licence: MN 3413) |
Enumeration Date | 2011-10-19 |
Last Update Date | 2017-12-05 |