NPI | 1194831123 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 152W00000X Optometrist (Licence: SC 1861) |
Additional Taxonomies | 152W00000X Optometrist (Licence: GA 3038) |
Enumeration Date | 2006-08-22 |
Last Update Date | 2019-04-14 |