NPI | 1851671739 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPC6613) |
Additional Taxonomies | 152W00000X Optometrist (Licence: NY TUV007779) |
152W00000X Optometrist (Licence: GA OPT003143) | |
Enumeration Date | 2011-08-23 |
Last Update Date | 2025-05-12 |