NPI | 1689639528 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: MD TA1167) |
Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: MD TA1167) |
152WP0200X Optometrist, Pediatrics (Licence: MD TA1167) | |
152WS0006X Optometrist, Sports Vision (Licence: MD TA1167) | |
Enumeration Date | 2006-04-20 |
Last Update Date | 2008-04-17 |