NPI | 1164685194 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 152W00000X Optometrist (Licence: CA 13481) |
Additional Taxonomies | 152W00000X Optometrist (Licence: NY 007498) |
152W00000X Optometrist (Licence: AZ 001797) | |
Enumeration Date | 2008-07-09 |
Last Update Date | 2016-11-22 |