NPI | 1174744155 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: GU OL-046) |
Additional Taxonomies | 152W00000X Optometrist (Licence: AK 123) |
Enumeration Date | 2007-05-01 |
Last Update Date | 2017-06-09 |