NPI | 1548376098 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 152W00000X Optometrist (Licence: WV 742-0) |
Additional Taxonomies | 152W00000X Optometrist (Licence: WV 7420) |
Enumeration Date | 2006-08-21 |
Last Update Date | 2008-11-12 |