NPI | 1700132719 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 152W00000X Optometrist (Licence: SC 1696) |
Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: SC 1696) |
152WP0200X Optometrist, Pediatrics (Licence: SC 1696) | |
Enumeration Date | 2012-07-27 |
Last Update Date | 2015-04-16 |