NPI | 1447483359 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPC4902) |
Additional Taxonomies | 152W00000X Optometrist (Licence: WA OD60102641) |
Enumeration Date | 2009-08-25 |
Last Update Date | 2015-05-05 |