NPI | 1346347457 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 152W00000X Optometrist (Licence: MA 3139) |
Additional Taxonomies | 152W00000X Optometrist (Licence: ID ODP-100055) |
Enumeration Date | 2006-09-20 |
Last Update Date | 2011-05-26 |