NPI | 1326007592 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 152WC0802X Optometrist, Corneal and Contact Management (Licence: TN odt694) |
Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: MT OPT-OPT-LIC-823) |
Enumeration Date | 2006-03-17 |
Last Update Date | 2017-06-27 |