NPI | 1083624878 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPC3380) |
Additional Taxonomies | 152W00000X Optometrist (Licence: TX 06362T) |
Enumeration Date | 2006-08-08 |
Last Update Date | 2011-11-07 |