| NPI | 1538210182 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: WA OD60276564) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CA 12485T) |
| Enumeration Date | 2007-01-12 |
| Last Update Date | 2018-12-04 |