NPI | 1023007416 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: NV 232) |
Additional Taxonomies | 152W00000X Optometrist (Licence: WY 179T) |
152W00000X Optometrist (Licence: CA 8563) | |
Enumeration Date | 2005-10-18 |
Last Update Date | 2012-08-01 |