NPI | 1508869298 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152WX0102X Optometrist Occupational Vision (Licence: WV WV723OD) |
Additional Taxonomies | 152WP0200X Optometrist Pediatrics (Licence: WV WV723OD) |
152WC0802X Optometrist Corneal and Contact Management (Licence: WV WV723OD) | |
152WS0006X Optometrist Sports Vision (Licence: WV WV723OD) | |
Enumeration Date | 2005-05-27 |
Last Update Date | 2007-10-16 |