NPI | 1801388392 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: PA OEG003596) |
Additional Taxonomies | 152W00000X Optometrist (Licence: OH OPT.006680) |
Enumeration Date | 2018-05-31 |
Last Update Date | 2024-02-15 |