| NPI | 1346348406 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AZ 1545) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: WA 1338) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2016-12-06 |