NPI | 1417019019 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: DC 0P1000115) |
Additional Taxonomies | 152W00000X Optometrist (Licence: VA 0618000015) |
Enumeration Date | 2006-12-14 |
Last Update Date | 2007-07-08 |