NPI | 1710997242 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: SC 1404) |
Additional Taxonomies | 152W00000X Optometrist (Licence: NJ OA 04767) |
Enumeration Date | 2006-08-08 |
Last Update Date | 2007-07-08 |