NPI | 1669751095 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: CA 14289TLG) |
Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: CA 14289TLG) |
152WP0200X Optometrist, Pediatrics (Licence: CA 14289TLG) | |
Enumeration Date | 2011-08-16 |
Last Update Date | 2019-04-04 |