NPI | 1922078583 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: CA 11597T) |
Additional Taxonomies | 152W00000X Optometrist (Licence: WA 3677) |
152W00000X Optometrist (Licence: OR 2912AT) | |
Enumeration Date | 2006-01-25 |
Last Update Date | 2019-02-27 |