NPI | 1831539105 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPC6627) |
Additional Taxonomies | 152W00000X Optometrist (Licence: MI 4901004774) |
152W00000X Optometrist (Licence: GA OPT003146) | |
Enumeration Date | 2013-07-01 |
Last Update Date | 2025-07-21 |