NPI | 1235129115 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: CO OPT2346) |
Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: CO 2346) |
Enumeration Date | 2005-10-24 |
Last Update Date | 2022-07-08 |