NPI | 1902860323 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 152W00000X Optometrist (Licence: SC 1333) |
Additional Taxonomies | 152W00000X Optometrist (Licence: OH 3329/T179) |
Enumeration Date | 2006-04-13 |
Last Update Date | 2007-10-11 |