| NPI | 1093790701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: WA OD00003590) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: AK 277) |
| Enumeration Date | 2005-12-14 |
| Last Update Date | 2023-03-07 |