NPI | 1679639678 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 152W00000X Optometrist (Licence: MA 3820) |
Additional Taxonomies | 152W00000X Optometrist (Licence: NH 0612) |
152W00000X Optometrist (Licence: GA 1398) | |
Enumeration Date | 2006-12-28 |
Last Update Date | 2010-06-28 |