NPI | 1811127525 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: NC 2154) |
Additional Taxonomies | 152W00000X Optometrist (Licence: WV 1065-OD) |
Enumeration Date | 2009-07-16 |
Last Update Date | 2010-12-01 |