NPI | 1841355245 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 152W00000X Optometrist (Licence: NV 751) |
Additional Taxonomies | 152W00000X Optometrist (Licence: UT 278987-9934) |
152W00000X Optometrist (Licence: ID 0DP-1068) | |
Enumeration Date | 2006-12-26 |
Last Update Date | 2014-01-15 |