NPI | 1154633113 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: WV 1081-OD) |
Additional Taxonomies | 152W00000X Optometrist (Licence: VA 0618001952) |
152W00000X Optometrist (Licence: MI L1832595) | |
Enumeration Date | 2010-07-07 |
Last Update Date | 2012-08-13 |