NPI | 1629570908 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 152W00000X Optometrist (Licence: WA 61079695) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
152W00000X Optometrist (Licence: HI OD-911) | |
Enumeration Date | 2018-03-02 |
Last Update Date | 2023-10-03 |