NPI | 1720196553 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 152W00000X Optometrist (Licence: WA OD00003258) |
Additional Taxonomies | 152W00000X Optometrist (Licence: OR 2563ATI) |
Enumeration Date | 2006-08-29 |
Last Update Date | 2018-10-02 |