NPI | 1609936558 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 152W00000X Optometrist (Licence: CA 35433) |
Additional Taxonomies | 152W00000X Optometrist (Licence: FL opc1771) |
Enumeration Date | 2006-12-11 |
Last Update Date | 2024-06-17 |