NPI | 1932155827 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: NE 915) |
Additional Taxonomies | 152W00000X Optometrist (Licence: IA 01937) |
152W00000X Optometrist (Licence: MN 2081) | |
Enumeration Date | 2006-05-25 |
Last Update Date | 2010-02-10 |