NPI | 1134103393 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: NV 557) |
Additional Taxonomies | 152W00000X Optometrist (Licence: CA 11887T) |
Enumeration Date | 2005-12-01 |
Last Update Date | 2012-04-26 |