NPI | 1831171206 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 152W00000X Optometrist (Licence: ME 836TA) |
Additional Taxonomies | 152W00000X Optometrist (Licence: NH 0698) |
Enumeration Date | 2005-11-18 |
Last Update Date | 2016-04-25 |