NPI | 1306220082 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 152W00000X Optometrist (Licence: NV 878) |
Additional Taxonomies | 152W00000X Optometrist (Licence: CA 15261) |
Enumeration Date | 2015-07-13 |
Last Update Date | 2022-07-21 |