NPI | 1902031578 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: MD TA2142) |
Additional Taxonomies | 152W00000X Optometrist (Licence: MD PENDING) |
Enumeration Date | 2009-05-26 |
Last Update Date | 2018-01-30 |