NPI | 1013205228 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 152W00000X Optometrist (Licence: CA 14536 TLG) |
Additional Taxonomies | 152W00000X Optometrist (Licence: NV 705) |
Enumeration Date | 2011-07-21 |
Last Update Date | 2021-12-22 |