NPI | 1982042925 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: MN 3362) |
Additional Taxonomies | 152W00000X Optometrist (Licence: NY 008021) |
Enumeration Date | 2013-06-12 |
Last Update Date | 2015-11-10 |