NPI | 1114110467 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: NY 008535) |
Additional Taxonomies | 152W00000X Optometrist (Licence: MD TA2333) |
Enumeration Date | 2007-08-21 |
Last Update Date | 2017-01-11 |