NPI | 1043362882 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: WA OD00000787) |
Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: WA MS1246897) |
Enumeration Date | 2007-01-18 |
Last Update Date | 2007-10-16 |