| NPI | 1346307055 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: WA OD00001225) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: WA TX00001225) |
| Enumeration Date | 2007-01-02 |
| Last Update Date | 2019-02-16 |