NPI | 1730122938 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: VA 0618001565) |
Additional Taxonomies | 152W00000X Optometrist (Licence: MD TA1956) |
152W00000X Optometrist (Licence: DC OP1000103) | |
Enumeration Date | 2006-06-14 |
Last Update Date | 2007-07-08 |