NPI | 1578623013 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: MD TA1030) |
Additional Taxonomies | 152W00000X Optometrist (Licence: VA 0618000579) |
152W00000X Optometrist (Licence: DC OP577) | |
Enumeration Date | 2006-12-12 |
Last Update Date | 2012-12-06 |