NPI | 1730180704 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: TN OD0000002541) |
Additional Taxonomies | 152W00000X Optometrist (Licence: TN OD2541) |
Enumeration Date | 2005-08-02 |
Last Update Date | 2021-01-22 |