| NPI | 1245210020 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OK 2430) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: OK 2430) |
| 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: OK 2430) | |
| 152WP0200X Optometrist, Pediatrics (Licence: OK 2430) | |
| Enumeration Date | 2006-01-18 |
| Last Update Date | 2024-06-12 |