NPI | 1942448675 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: MI 4901004630) |
Additional Taxonomies | 152W00000X Optometrist (Licence: IN 18003559) |
Enumeration Date | 2009-02-03 |
Last Update Date | 2017-03-24 |