NPI | 1326119223 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 152W00000X Optometrist (Licence: MN LD1652000) |
Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: MN LD1652000) |
152WX0102X Optometrist, Occupational Vision (Licence: MN LD1652000) | |
152WX0102X Optometrist, Occupational Vision (Licence: ND 362) | |
Enumeration Date | 2006-11-13 |
Last Update Date | 2013-12-27 |