NPI | 1972507614 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: TN odt2014) |
Additional Taxonomies | 152WP0200X Optometrist, Pediatrics (Licence: TN odt2014) |
152WV0400X Optometrist, Vision Therapy (Licence: TN odt2014) | |
Enumeration Date | 2005-06-10 |
Last Update Date | 2008-02-13 |