NPI | 1376650903 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 152W00000X Optometrist (Licence: NC 1271) |
Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: NC 1271) |
152WP0200X Optometrist, Pediatrics (Licence: NC 1271) | |
152WS0006X Optometrist, Sports Vision (Licence: NC 1271) | |
Enumeration Date | 2006-08-23 |
Last Update Date | 2010-07-27 |