NPI | 1194756577 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: TN 1612) |
Additional Taxonomies | 152W00000X Optometrist (Licence: GA OPT002126) |
Enumeration Date | 2006-07-05 |
Last Update Date | 2015-05-06 |