NPI | 1013961663 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: DE I3-0001292) |
Additional Taxonomies | 152W00000X Optometrist (Licence: PA OEG001481) |
Enumeration Date | 2006-05-19 |
Last Update Date | 2014-09-04 |