NPI | 1376959395 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: CA 15094TLG) |
Additional Taxonomies | 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: CA 15094TLG) |
Enumeration Date | 2014-07-10 |
Last Update Date | 2016-02-08 |