NPI | 1942535026 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: AZ 1924) |
Additional Taxonomies | 152W00000X Optometrist (Licence: OR 3438ATI) |
152W00000X Optometrist (Licence: WY 335T) | |
Enumeration Date | 2009-10-07 |
Last Update Date | 2023-06-14 |