NPI | 1215989603 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: TN 1409) |
Additional Taxonomies | 152W00000X Optometrist (Licence: OH 4003) |
Enumeration Date | 2006-05-16 |
Last Update Date | 2008-07-08 |