NPI | 1629209531 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPC 4449) |
Additional Taxonomies | 152W00000X Optometrist (Licence: PA OEG002251) |
Enumeration Date | 2009-07-27 |
Last Update Date | 2009-10-27 |