NPI | 1114922127 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: OH 2908 T455) |
Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: OH 2908/T455) |
152WS0006X Optometrist, Sports Vision (Licence: OH 2908/T455) | |
Enumeration Date | 2005-06-16 |
Last Update Date | 2016-01-08 |