NPI | 1528188596 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 152W00000X Optometrist (Licence: AK 061) |
Additional Taxonomies | 152W00000X Optometrist (Licence: CA 4352) |
Enumeration Date | 2007-03-31 |
Last Update Date | 2007-07-09 |