NPI | 1528355872 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 152W00000X Optometrist (Licence: CA 14277 TGL) |
Additional Taxonomies | 152W00000X Optometrist (Licence: PA OEG002482) |
Enumeration Date | 2011-07-07 |
Last Update Date | 2015-08-11 |