NPI | 1013033059 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: CA 5790T) |
Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: CA 5790T) |
Enumeration Date | 2007-03-21 |
Last Update Date | 2014-05-02 |