NPI | 1396991402 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: PA OEG002113) |
Additional Taxonomies | 152W00000X Optometrist (Licence: CA 13585) |
Enumeration Date | 2008-08-09 |
Last Update Date | 2017-05-01 |