| NPI | 1205814183 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: WA 3385) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TX 5535-T) |
| Enumeration Date | 2006-01-03 |
| Last Update Date | 2020-09-23 |