NPI | 1053484816 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: MN 1472) |
Additional Taxonomies | 152W00000X Optometrist (Licence: WI 1308035) |
Enumeration Date | 2006-11-17 |
Last Update Date | 2007-07-08 |