NPI | 1699089201 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: MD TA2203) |
Additional Taxonomies | 152W00000X Optometrist (Licence: VA 0618001936) |
Enumeration Date | 2010-08-06 |
Last Update Date | 2011-08-17 |