NPI | 1841344736 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 152WC0802X Optometrist, Corneal and Contact Management (Licence: GA OPT001132) |
Additional Taxonomies | 152WP0200X Optometrist, Pediatrics (Licence: GA OPT001132) |
152WS0006X Optometrist, Sports Vision (Licence: GA OPT001132) | |
152WX0102X Optometrist, Occupational Vision (Licence: GA OPT001132) | |
Enumeration Date | 2007-01-22 |
Last Update Date | 2024-05-04 |