NPI | 1831547900 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: KS 2038) |
Additional Taxonomies | 152W00000X Optometrist (Licence: MO 2016020857) |
Enumeration Date | 2016-05-31 |
Last Update Date | 2020-07-13 |