NPI | 1710061643 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 152W00000X Optometrist (Licence: LA 1075 - 250T) |
Additional Taxonomies | 152W00000X Optometrist (Licence: MS 664-94236) |
152W00000X Optometrist (Licence: WI 2583-035) | |
Enumeration Date | 2006-10-25 |
Last Update Date | 2018-04-27 |