NPI | 1164084315 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: WA OD61310557) |
Additional Taxonomies | 152W00000X Optometrist (Licence: AZ OPT-002354) |
Enumeration Date | 2019-07-08 |
Last Update Date | 2022-10-28 |