NPI | 1255377040 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: NV 335) |
Additional Taxonomies | 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: NV 335) |
Enumeration Date | 2006-06-21 |
Last Update Date | 2019-02-23 |