NPI | 1871002170 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 152W00000X Optometrist (Licence: NE 1481) |
Additional Taxonomies | 152W00000X Optometrist (Licence: TX 9353T) |
152W00000X Optometrist (Licence: IA 091285) | |
Enumeration Date | 2017-09-29 |
Last Update Date | 2022-12-19 |