NPI | 1316939051 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 152W00000X Optometrist (Licence: MO 2008-026019) |
Additional Taxonomies | 152W00000X Optometrist (Licence: KS 12392) |
152W00000X Optometrist (Licence: MO 2008026019) | |
Enumeration Date | 2005-08-18 |
Last Update Date | 2011-05-24 |