NPI | 1972589273 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: HI OD-854) |
Additional Taxonomies | 152W00000X Optometrist (Licence: NV 512) |
Enumeration Date | 2005-12-19 |
Last Update Date | 2017-05-04 |