NPI | 1215974548 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: NC 1267) |
Additional Taxonomies | 152W00000X Optometrist (Licence: NC 1267) |
152WL0500X Optometrist, Low Vision Rehabilitation (Licence: SC 1182) | |
Enumeration Date | 2006-06-02 |
Last Update Date | 2021-03-17 |