NPI | 1023241437 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 152W00000X Optometrist (Licence: MO 2010020480) |
Additional Taxonomies | 152W00000X Optometrist (Licence: IL 046.010363) |
Enumeration Date | 2009-09-01 |
Last Update Date | 2014-01-07 |