NPI | 1053486357 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: FL OFC14) |
Additional Taxonomies | 152W00000X Optometrist (Licence: TX 2635T) |
Enumeration Date | 2006-11-21 |
Last Update Date | 2007-07-08 |