NPI | 1699872846 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 152W00000X Optometrist (Licence: CO 1288) |
Additional Taxonomies | 152W00000X Optometrist (Licence: WY 301T) |
Enumeration Date | 2006-09-20 |
Last Update Date | 2007-07-08 |