NPI | 1912210527 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: PA OEG002385) |
Additional Taxonomies | 152W00000X Optometrist (Licence: AZ OPT-002821) |
Enumeration Date | 2010-07-24 |
Last Update Date | 2025-01-17 |