NPI | 1306036421 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 152W00000X Optometrist (Licence: CA 13657) |
Additional Taxonomies | 152W00000X Optometrist (Licence: OH 5720) |
152W00000X Optometrist (Licence: VA 0618001899) | |
Enumeration Date | 2007-07-25 |
Last Update Date | 2014-06-18 |