NPI | 1104934686 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: ID ODP-796) |
Additional Taxonomies | 152W00000X Optometrist (Licence: WA OD00003705) |
Enumeration Date | 2006-08-26 |
Last Update Date | 2007-07-08 |