NPI | 1396896338 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: VA 0618001118) |
Additional Taxonomies | 152W00000X Optometrist (Licence: DC OP633) |
152W00000X Optometrist (Licence: MD TA1063m) | |
Enumeration Date | 2007-01-16 |
Last Update Date | 2007-07-08 |