NPI | 1003915398 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 152W00000X Optometrist (Licence: WA WA OD00001042) |
Additional Taxonomies | 152W00000X Optometrist (Licence: OR OR 1391T) |
Enumeration Date | 2006-09-22 |
Last Update Date | 2007-07-11 |