NPI | 1235212085 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: LA 931158T) |
Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: LA 931-158T) |
Enumeration Date | 2006-10-23 |
Last Update Date | 2017-07-19 |