NPI | 1386997856 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: WA OD 60298166) |
Additional Taxonomies | 152W00000X Optometrist (Licence: OR 3475ATI) |
152W00000X Optometrist (Licence: ID ODP-100262) | |
Enumeration Date | 2012-10-22 |
Last Update Date | 2018-03-17 |