NPI | 1386639110 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 152W00000X Optometrist (Licence: LA 809097T) |
Additional Taxonomies | 332H00000X Eyewear Supplier (Licence: LA 152W00000X) |
Enumeration Date | 2005-09-19 |
Last Update Date | 2008-12-16 |