NPI | 1598078628 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: LA 1604-637T) |
Additional Taxonomies | 152W00000X Optometrist (Licence: TX 7544T) |
Enumeration Date | 2010-07-18 |
Last Update Date | 2012-05-21 |