NPI | 1619943370 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: TX 10795) |
Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: CA 12504 TPA) |
152WC0802X Optometrist, Corneal and Contact Management (Licence: AZ 1439) | |
152WC0802X Optometrist, Corneal and Contact Management (Licence: NV 781) | |
Enumeration Date | 2006-02-23 |
Last Update Date | 2023-07-26 |