| NPI | 1497286496 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA 33628) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: WA 60707338) |
| Enumeration Date | 2017-03-22 |
| Last Update Date | 2017-03-22 |