NPI | 1912030750 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 152W00000X Optometrist (Licence: NV 916) |
Additional Taxonomies | 152W00000X Optometrist (Licence: NJ 27OA00511100) |
152W00000X Optometrist (Licence: NY TUV005156) | |
Enumeration Date | 2007-03-13 |
Last Update Date | 2021-12-12 |