NPI | 1821472267 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 152W00000X Optometrist (Licence: MS 923) |
Additional Taxonomies | 152W00000X Optometrist (Licence: AL R-295-TA-C49) |
152W00000X Optometrist (Licence: VA 0618003092) | |
152W00000X Optometrist (Licence: WI 3847-35) | |
Enumeration Date | 2015-07-15 |
Last Update Date | 2023-03-06 |