NPI | 1396715512 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 152W00000X Optometrist (Licence: DE I30001138) |
Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: DE I3-0001138) |
Enumeration Date | 2006-01-23 |
Last Update Date | 2007-11-15 |