NPI | 1568777076 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: CA 14584) |
Additional Taxonomies | 152W00000X Optometrist (Licence: TN 2947) |
152WC0802X Optometrist, Corneal and Contact Management (Licence: TN 2947) | |
Enumeration Date | 2010-08-10 |
Last Update Date | 2013-10-23 |