NPI | 1205106648 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: MD TA2257) |
Additional Taxonomies | 152WP0200X Optometrist, Pediatrics (Licence: MD TA2257) |
Enumeration Date | 2012-01-02 |
Last Update Date | 2021-08-12 |