NPI | 1013057728 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 152W00000X Optometrist (Licence: MD TA0780) |
Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: MD TA0780) |
152WP0200X Optometrist, Pediatrics (Licence: MD TA0780) | |
152WS0006X Optometrist, Sports Vision (Licence: MD TA0780) | |
152WX0102X Optometrist, Occupational Vision (Licence: MD TA0780) | |
Enumeration Date | 2007-02-08 |
Last Update Date | 2007-07-08 |