NPI | 1447549514 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 152W00000X Optometrist (Licence: CA 35553) |
Additional Taxonomies | 124Q00000X Dental Hygienist (Licence: CA 25351) |
Enumeration Date | 2011-03-29 |
Last Update Date | 2023-07-05 |