NPI | 1992952048 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: WA 60188658) |
Additional Taxonomies | 152W00000X Optometrist (Licence: HI 688) |
Enumeration Date | 2008-08-20 |
Last Update Date | 2016-01-29 |