| NPI | 1144223405 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: WA OD00001765) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CA 9074) |
| Enumeration Date | 2005-05-31 |
| Last Update Date | 2023-03-07 |