NPI | 1073506408 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 152W00000X Optometrist (Licence: TN OD0000001727) |
Additional Taxonomies | 152WC0802X Optometrist Corneal and Contact Management (Licence: TN OD0000001727) |
152WP0200X Optometrist Pediatrics (Licence: TN OD0000001727) | |
152WV0400X Optometrist Vision Therapy (Licence: TN OD0000001727) | |
Enumeration Date | 2005-08-31 |
Last Update Date | 2012-12-03 |