NPI | 1871750133 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: MD TA2084) |
Additional Taxonomies | 152W00000X Optometrist (Licence: GA OPT002572) |
152W00000X Optometrist (Licence: VA 0618002532) | |
152WC0802X Optometrist, Corneal and Contact Management (Licence: MD DA 2084) | |
152WS0006X Optometrist, Sports Vision (Licence: MD DA 2084) | |
Enumeration Date | 2008-05-22 |
Last Update Date | 2023-08-09 |