NPI | 1861491946 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: NY VUT004901-1) |
Additional Taxonomies | 152W00000X Optometrist (Licence: NV 508) |
Enumeration Date | 2005-07-20 |
Last Update Date | 2015-09-03 |