NPI | 1104011485 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 152W00000X Optometrist (Licence: NY 007387) |
Additional Taxonomies | 152W00000X Optometrist (Licence: TN 2780) |
Enumeration Date | 2007-09-11 |
Last Update Date | 2009-05-04 |