NPI | 1275897910 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 152W00000X Optometrist (Licence: WA 60351117) |
Additional Taxonomies | 152WV0400X Optometrist, Vision Therapy (Licence: WA 60351117) |
Enumeration Date | 2012-06-27 |
Last Update Date | 2019-01-17 |