NPI | 1275526535 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: KS 11503) |
Additional Taxonomies | 152W00000X Optometrist (Licence: MO T02413) |
Enumeration Date | 2005-08-23 |
Last Update Date | 2011-12-19 |