NPI | 1689689101 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 152W00000X Optometrist (Licence: KY KY1973DT) |
Additional Taxonomies | 152W00000X Optometrist (Licence: NJ 27OA00340800) |
Enumeration Date | 2006-07-31 |
Last Update Date | 2016-01-27 |