NPI | 1003149113 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: NC 2174) |
Additional Taxonomies | 152W00000X Optometrist (Licence: HI 703) |
Enumeration Date | 2009-09-09 |
Last Update Date | 2016-03-10 |