NPI | 1710977574 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 152W00000X Optometrist (Licence: CA 6588T) |
Additional Taxonomies | 332H00000X Eyewear Supplier (Equipment, not the service) |
Enumeration Date | 2005-10-24 |
Last Update Date | 2015-02-11 |