| NPI | 1447267885 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: WA OD60304885) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CA 13119) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2012-10-11 |