NPI | 1073553111 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: CA 5998T) |
Additional Taxonomies | 152W00000X Optometrist (Licence: WA 2004) |
152W00000X Optometrist (Licence: TN 1981) | |
152W00000X Optometrist (Licence: AZ 23) | |
Enumeration Date | 2006-06-07 |
Last Update Date | 2007-07-12 |