NPI | 1568556132 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: KY 1753DT) |
Additional Taxonomies | 152W00000X Optometrist (Licence: OH 5663) |
Enumeration Date | 2006-10-03 |
Last Update Date | 2011-11-04 |