NPI | 1043545122 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: OR 3462ATI) |
Additional Taxonomies | 152W00000X Optometrist (Licence: WA OD 60290877) |
Enumeration Date | 2009-10-07 |
Last Update Date | 2013-01-31 |