NPI | 1730136979 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: VA 0618000581) |
Additional Taxonomies | 152W00000X Optometrist (Licence: MD TA0609) |
Enumeration Date | 2006-05-30 |
Last Update Date | 2008-08-01 |