NPI | 1295812055 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: MD TA0610) |
Additional Taxonomies | 152W00000X Optometrist (Licence: VA 0618000615) |
Enumeration Date | 2006-11-01 |
Last Update Date | 2007-07-08 |