NPI | 1740316041 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: CA 14376) |
Additional Taxonomies | 152W00000X Optometrist (Licence: CA 41376) |
152W00000X Optometrist (Licence: WA 3812) | |
Enumeration Date | 2007-02-23 |
Last Update Date | 2022-07-27 |