NPI | 1699087437 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 152W00000X Optometrist (Licence: ID 100220) |
Additional Taxonomies | 152W00000X Optometrist (Licence: OH 5947) |
Enumeration Date | 2010-07-09 |
Last Update Date | 2013-08-20 |