NPI | 1710268206 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 152W00000X Optometrist (Licence: OH OPT.007122) |
Additional Taxonomies | 152W00000X Optometrist (Licence: CA 15382) |
Enumeration Date | 2011-08-29 |
Last Update Date | 2023-07-13 |