NPI | 1679686810 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: PA OEG002553) |
Additional Taxonomies | 152W00000X Optometrist (Licence: CA 11603T) |
Enumeration Date | 2006-08-15 |
Last Update Date | 2011-12-30 |