NPI | 1982695524 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: OR 1610AT) |
Additional Taxonomies | 152W00000X Optometrist (Licence: OK 1012) |
Enumeration Date | 2005-11-02 |
Last Update Date | 2007-07-08 |