| NPI | 1184719296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OR 1780ATI) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: WA OD 00001663) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2022-02-10 |