NPI | 1659487866 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 152W00000X Optometrist (Licence: CA 13415 T) |
Additional Taxonomies | 152W00000X Optometrist (Licence: NY TUV007090) |
Enumeration Date | 2006-08-21 |
Last Update Date | 2011-12-13 |