NPI | 1184631475 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 152W00000X Optometrist (Licence: UT 109296-9934) |
Additional Taxonomies | 152W00000X Optometrist (Licence: IN 18001659A) |
Enumeration Date | 2006-08-01 |
Last Update Date | 2007-07-16 |