NPI | 1114369709 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 152W00000X Optometrist (Licence: CA 15363T) |
Additional Taxonomies | 152WV0400X Optometrist, Vision Therapy (Licence: CA 15363T) |
Enumeration Date | 2013-07-23 |
Last Update Date | 2019-12-19 |