NPI | 1164854725 |
---|---|
Former Name | ANNE MINNA SONG |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: WA OD60387573) |
Additional Taxonomies | 152W00000X Optometrist (Licence: OR 3516AT) |
Enumeration Date | 2013-08-06 |
Last Update Date | 2019-06-05 |