NPI | 1548226822 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 152W00000X Optometrist (Licence: SC 503) |
Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: SC 503) |
152WP0200X Optometrist, Pediatrics (Licence: SC 503) | |
152WS0006X Optometrist, Sports Vision (Licence: SC 503) | |
152WV0400X Optometrist, Vision Therapy (Licence: SC 503) | |
Enumeration Date | 2006-04-25 |
Last Update Date | 2007-11-15 |