NPI | 1497931687 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 152W00000X Optometrist (Licence: LA 1539571T) |
Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: LA 1539571T) |
Enumeration Date | 2008-01-17 |
Last Update Date | 2008-05-16 |