NPI | 1184794745 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: CO 2025) |
Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: WY 209T) |
152WC0802X Optometrist, Corneal and Contact Management (Licence: CO 2025) | |
Enumeration Date | 2006-11-09 |
Last Update Date | 2022-11-02 |