NPI | 1457334740 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 152W00000X Optometrist (Licence: UT 375881-9934) |
Additional Taxonomies | 152W00000X Optometrist (Licence: NV 361) |
Enumeration Date | 2005-11-21 |
Last Update Date | 2018-03-02 |