NPI | 1598740367 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: TX 3995TG) |
Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: TX 3995TG) |
152WS0006X Optometrist, Sports Vision (Licence: TX 3995TG) | |
Enumeration Date | 2005-12-14 |
Last Update Date | 2018-03-17 |