NPI | 1790906378 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 152W00000X Optometrist (Licence: MD TA0814) |
Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: MD TA0814) |
Enumeration Date | 2007-05-01 |
Last Update Date | 2016-06-20 |