NPI | 1619932720 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: NE 1225) |
Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: IA 2293) |
152WP0200X Optometrist, Pediatrics (Licence: IA 2293) | |
Enumeration Date | 2006-04-20 |
Last Update Date | 2007-11-09 |