NPI | 1912061078 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 152W00000X Optometrist (Licence: CA 7841T) |
Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: CA 7841T) |
Enumeration Date | 2006-12-21 |
Last Update Date | 2007-07-08 |