NPI | 1740438506 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 152W00000X Optometrist (Licence: CA 13624) |
Additional Taxonomies | 152W00000X Optometrist (Licence: WA OD60033593) |
Enumeration Date | 2008-09-05 |
Last Update Date | 2012-02-14 |