NPI | 1144229394 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: WA OD00003839) |
Additional Taxonomies | 152W00000X Optometrist (Licence: OR AT2798) |
152W00000X Optometrist (Licence: AK OPTT308) | |
Enumeration Date | 2005-07-19 |
Last Update Date | 2020-12-07 |