NPI | 1497801633 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 152W00000X Optometrist (Licence: WA 1642) |
Additional Taxonomies | 152W00000X Optometrist (Licence: OR 1758ATI) |
152W00000X Optometrist (Licence: WY 169) | |
Enumeration Date | 2007-01-27 |
Last Update Date | 2007-07-09 |