| NPI | 1689774218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OR OR-2299AT) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: WA WA-OD00002027) |
| Enumeration Date | 2006-09-24 |
| Last Update Date | 2007-07-08 |