| NPI | 1548372717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OR 2884T) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: WA 4041) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2022-02-11 |