NPI | 1316040314 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: LA 885189T) |
Additional Taxonomies | 207W00000X Ophthalmology (Licence: LA MD026103) |
Enumeration Date | 2006-09-06 |
Last Update Date | 2009-10-07 |