| NPI | 1518304435 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: UT 8684413-9934) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: WA OD60401345) |
| Enumeration Date | 2013-06-01 |
| Last Update Date | 2023-10-27 |