NPI | 1801902333 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: UT 62492069934) |
Additional Taxonomies | 152W00000X Optometrist (Licence: ID ODP100129) |
Enumeration Date | 2006-08-21 |
Last Update Date | 2011-03-01 |