NPI | 1972700995 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 152W00000X Optometrist (Licence: TX 6844T) |
Additional Taxonomies | 152W00000X Optometrist (Licence: OK 2411) |
152W00000X Optometrist (Licence: WA 3654) | |
152W00000X Optometrist (Licence: IN 18003109A) | |
Enumeration Date | 2007-07-02 |
Last Update Date | 2009-12-06 |