NPI | 1770979940 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: CO OPT.0003285) |
Additional Taxonomies | 152W00000X Optometrist (Licence: CA 15149) |
Enumeration Date | 2015-04-14 |
Last Update Date | 2024-05-08 |