NPI | 1871584581 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: CA OPT5933TPA) |
Additional Taxonomies | 152W00000X Optometrist (Licence: CA 5933) |
Enumeration Date | 2005-11-02 |
Last Update Date | 2010-08-20 |