NPI | 1972522829 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: DE 13-0001239) |
Additional Taxonomies | 152W00000X Optometrist (Licence: DE 130001239) |
Enumeration Date | 2006-07-19 |
Last Update Date | 2015-06-08 |