NPI | 1679020283 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 152W00000X Optometrist (Licence: CA 33506 TLG) |
Additional Taxonomies | 152W00000X Optometrist (Licence: ZZ GOC 01-20989) |
Enumeration Date | 2016-09-01 |
Last Update Date | 2019-11-01 |