NPI | 1992721039 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: MD TA1812) |
Additional Taxonomies | 152W00000X Optometrist (Licence: NY TUV 004236-1) |
Enumeration Date | 2006-07-14 |
Last Update Date | 2007-07-08 |