NPI | 1972142545 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: PA OEG003850) |
Additional Taxonomies | 152W00000X Optometrist (Licence: MD TA2748) |
Enumeration Date | 2019-12-31 |
Last Update Date | 2021-10-11 |