NPI | 1619084910 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: WA OD00003477) |
Additional Taxonomies | 152W00000X Optometrist (Licence: OR ATI2863) |
152W00000X Optometrist (Licence: AK OPTT200) | |
Enumeration Date | 2006-08-23 |
Last Update Date | 2020-11-19 |