NPI | 1811059421 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: DC OP744) |
Additional Taxonomies | 152W00000X Optometrist (Licence: MD TA1334) |
Enumeration Date | 2006-12-14 |
Last Update Date | 2011-12-23 |