NPI | 1285624601 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 152W00000X Optometrist (Licence: ID ODP100067) |
Additional Taxonomies | 152W00000X Optometrist (Licence: WA OD00003976) |
Enumeration Date | 2005-10-26 |
Last Update Date | 2023-08-23 |