NPI | 1487735767 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 152W00000X Optometrist (Licence: MD 0579) |
Additional Taxonomies | 152W00000X Optometrist (Licence: DC DC0323) |
Enumeration Date | 2006-10-17 |
Last Update Date | 2011-01-18 |