| NPI | 1538251905 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: WA OD00004039TX) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: FL OPC 3627) |
| Enumeration Date | 2006-09-29 |
| Last Update Date | 2018-09-20 |