NPI | 1669096020 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: UT 11777686-9934) |
Additional Taxonomies | 152WP0200X Optometrist, Pediatrics (Licence: UT 11777686-9934) |
152WS0006X Optometrist, Sports Vision (Licence: UT 11777686-9934) | |
152WV0400X Optometrist, Vision Therapy (Licence: UT 11777686-9934) | |
Enumeration Date | 2020-06-02 |
Last Update Date | 2020-06-02 |