NPI | 1144340217 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 152W00000X Optometrist (Licence: MI 4901002317) |
Additional Taxonomies | 152W00000X Optometrist (Licence: CA 7568) |
152W00000X Optometrist (Licence: GA 1987) | |
Enumeration Date | 2007-03-30 |
Last Update Date | 2007-07-08 |