NPI | 1073917068 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: CA 15140) |
Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: CA 15140) |
152WL0500X Optometrist, Low Vision Rehabilitation (Licence: CA 15140) | |
Enumeration Date | 2014-10-20 |
Last Update Date | 2014-10-20 |