NPI | 1588725261 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: KS KS1345) |
Additional Taxonomies | 152W00000X Optometrist (Licence: MO T02980) |
Enumeration Date | 2006-12-13 |
Last Update Date | 2007-07-08 |