NPI | 1578564522 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 152W00000X Optometrist (Licence: KS 1264-3) |
Additional Taxonomies | 152W00000X Optometrist (Licence: KS 1264-2) |
Enumeration Date | 2005-08-02 |
Last Update Date | 2011-11-05 |