| NPI | 1689392342 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: WA OD61330317) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CA 35201TLG) |
| Enumeration Date | 2022-08-18 |
| Last Update Date | 2024-07-29 |