| NPI | 1023009610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OR 2885AT) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: WA OD3772) |
| 152W00000X Optometrist (Licence: CA OPT11957TPA) | |
| Enumeration Date | 2005-11-02 |
| Last Update Date | 2011-05-31 |