NPI | 1871642207 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: NY VUT006286) |
Additional Taxonomies | 152W00000X Optometrist (Licence: CA 11546TPA) |
Enumeration Date | 2007-01-08 |
Last Update Date | 2013-05-10 |