NPI | 1972537488 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 152W00000X Optometrist (Licence: TX 6850T) |
Additional Taxonomies | 152W00000X Optometrist (Licence: NJ 4903) |
Enumeration Date | 2006-07-10 |
Last Update Date | 2007-07-08 |