| NPI | 1174837579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: WA 60172882) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: AZ 2236) |
| Enumeration Date | 2010-07-28 |
| Last Update Date | 2023-11-29 |