NPI | 1164090809 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: PA OEG003795) |
Additional Taxonomies | 152W00000X Optometrist (Licence: NJ 27OA00712200) |
152WC0802X Optometrist, Corneal and Contact Management (Licence: NJ 27OA00712200) | |
Enumeration Date | 2021-06-17 |
Last Update Date | 2022-08-15 |