NPI | 1225324023 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: NV 896) |
Additional Taxonomies | 152W00000X Optometrist (Licence: CA 14157TLG) |
Enumeration Date | 2011-06-21 |
Last Update Date | 2020-10-16 |