NPI | 1881033751 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 152W00000X Optometrist (Licence: CO 0003575) |
Additional Taxonomies | 152W00000X Optometrist (Licence: ND 708) |
152WC0802X Optometrist, Corneal and Contact Management (Licence: ND 708) | |
152WS0006X Optometrist, Sports Vision (Licence: ND 708) | |
390200000X Student in an Organized Health Care Education/Training Program (Licence: OR 152W00000X) | |
Enumeration Date | 2013-06-24 |
Last Update Date | 2021-08-18 |