NPI | 1750373411 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: UT 4944080-9934) |
Additional Taxonomies | 152WC0802X Optometrist Corneal and Contact Management (Licence: UT 4944080-9934) |
Enumeration Date | 2005-08-18 |
Last Update Date | 2024-03-25 |