NPI | 1134133960 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 152W00000X Optometrist (Licence: AZ OPT002834) |
Additional Taxonomies | 152W00000X Optometrist (Licence: UT 6255330-8908) |
152WL0500X Optometrist, Low Vision Rehabilitation (Licence: UT 6255330-9934) | |
152WV0400X Optometrist, Vision Therapy (Licence: UT 6255330-9934) | |
Enumeration Date | 2006-07-28 |
Last Update Date | 2024-11-21 |