| NPI | 1356724009 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AZ OPT-002879) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: WA OD60575490) |
| Enumeration Date | 2015-06-30 |
| Last Update Date | 2026-01-26 |