NPI | 1689682957 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 152W00000X Optometrist (Licence: AR AR2327) |
Additional Taxonomies | 152W00000X Optometrist (Licence: TX 5994T) |
Enumeration Date | 2006-08-03 |
Last Update Date | 2012-03-06 |