| NPI | 1265484604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: ID 1000020) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: WA OD00003408) |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2010-10-21 |