NPI | 1942740212 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: MO 2017006443) |
Additional Taxonomies | 152W00000X Optometrist (Licence: IL 046011080) |
Enumeration Date | 2017-03-06 |
Last Update Date | 2024-10-09 |