NPI | 1265621882 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: TX 7799T) |
Additional Taxonomies | 152W00000X Optometrist (Licence: GA OPT002244) |
Enumeration Date | 2007-10-19 |
Last Update Date | 2016-12-12 |