NPI | 1063448983 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: MD TA0679) |
Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: MD TA0679) |
152WP0200X Optometrist, Pediatrics (Licence: MD TA0679) | |
152WS0006X Optometrist, Sports Vision (Licence: MD TA0679) | |
152WV0400X Optometrist, Vision Therapy (Licence: MD TA0679) | |
Enumeration Date | 2006-06-23 |
Last Update Date | 2010-03-09 |