NPI | 1417934316 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: CA OPT-110408LTG) |
Additional Taxonomies | 152W00000X Optometrist (Licence: CA OPT11408T) |
Enumeration Date | 2005-12-30 |
Last Update Date | 2010-10-20 |