NPI | 1922569938 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: CA OPT34640) |
Additional Taxonomies | 152W00000X Optometrist (Licence: AZ OPT-002373) |
Enumeration Date | 2019-03-31 |
Last Update Date | 2021-12-08 |