NPI | 1669447181 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPC001929) |
Additional Taxonomies | 152W00000X Optometrist (Licence: NC 1152) |
Enumeration Date | 2006-02-19 |
Last Update Date | 2007-07-08 |