NPI | 1902353238 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 152W00000X Optometrist (Licence: CA 34111) |
Additional Taxonomies | 152W00000X Optometrist (Licence: NV 894) |
Enumeration Date | 2016-09-02 |
Last Update Date | 2019-02-07 |