| NPI | 1366704959 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: UT 8335601-9934) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: WA OD60459056) |
| Enumeration Date | 2012-06-11 |
| Last Update Date | 2022-07-21 |