NPI | 1962841981 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: IL 046010662) |
Additional Taxonomies | 152W00000X Optometrist (Licence: TN 3368) |
Enumeration Date | 2013-06-24 |
Last Update Date | 2020-08-24 |