NPI | 1184935009 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: VA 0618001181) |
Additional Taxonomies | 152W00000X Optometrist (Licence: CA 14132) |
Enumeration Date | 2010-06-24 |
Last Update Date | 2013-06-25 |