NPI | 1255887857 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: CA 33521) |
Additional Taxonomies | 152W00000X Optometrist (Licence: CA OPT33521-TLG) |
Enumeration Date | 2016-09-01 |
Last Update Date | 2022-07-21 |