NPI | 1407502065 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 246Z00000X Specialist/Technologist, Other |
Additional Taxonomies | 156FX1202X Technician/Technologist, Optometric Technician |
156FX1100X Technician/Technologist, Ophthalmic | |
156FX1800X Technician/Technologist, Optician | |
Enumeration Date | 2022-02-22 |
Last Update Date | 2024-02-22 |