NPI | 1770627945 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 152W00000X Optometrist (Licence: WA OD00003181) |
Additional Taxonomies | 152W00000X Optometrist (Licence: WA WA3181TX) |
Enumeration Date | 2007-02-19 |
Last Update Date | 2022-09-15 |