NPI | 1205035037 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: IN 18003539A) |
Additional Taxonomies | 152W00000X Optometrist (Licence: OH 5698) |
Enumeration Date | 2007-07-12 |
Last Update Date | 2014-09-09 |