NPI | 1881841492 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPC4384) |
Additional Taxonomies | 152W00000X Optometrist (Licence: VA 0618001793) |
152W00000X Optometrist (Licence: MD TA2116) | |
152W00000X Optometrist (Licence: PA OEG002140) | |
Enumeration Date | 2008-08-26 |
Last Update Date | 2022-11-08 |