NPI | 1811329824 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: CA OD33555TLG) |
Additional Taxonomies | 152W00000X Optometrist (Licence: WA OD60562268) |
152W00000X Optometrist (Licence: MA 5018) | |
152W00000X Optometrist (Licence: PA OEG002754) | |
Enumeration Date | 2013-07-31 |
Last Update Date | 2021-11-29 |