NPI | 1083639181 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: CA 9483T) |
Additional Taxonomies | 152W00000X Optometrist (Licence: TN 2223) |
152W00000X Optometrist (Licence: WA 3236) | |
Enumeration Date | 2006-07-12 |
Last Update Date | 2013-02-05 |