NPI | 1255439162 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: WA OD00003719) |
Additional Taxonomies | 152W00000X Optometrist (Licence: OR 2841T) |
Enumeration Date | 2006-09-21 |
Last Update Date | 2022-02-04 |