NPI | 1154763662 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: NV 766) |
Additional Taxonomies | 152W00000X Optometrist (Licence: CA 14622) |
Enumeration Date | 2013-07-25 |
Last Update Date | 2016-01-28 |