NPI | 1083739387 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 152W00000X Optometrist (Licence: LA 1546-581T) |
Additional Taxonomies | 152W00000X Optometrist (Licence: PA OEG001889) |
Enumeration Date | 2007-03-19 |
Last Update Date | 2016-02-19 |