NPI | 1235825985 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: WV 3029-IOD) |
Additional Taxonomies | 152W00000X Optometrist (Licence: WV 3029-IOD) |
Enumeration Date | 2023-04-14 |
Last Update Date | 2024-11-12 |