NPI | 1902837891 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 152W00000X Optometrist (Licence: TX 3360TG) |
Additional Taxonomies | 152W00000X Optometrist (Licence: VA 1238) |
Enumeration Date | 2006-07-06 |
Last Update Date | 2014-11-26 |