NPI | 1255783106 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: CA 34420TLG) |
Additional Taxonomies | 152W00000X Optometrist (Licence: MD TA2544) |
Enumeration Date | 2016-07-04 |
Last Update Date | 2023-05-30 |