| NPI | 1720021330 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: WA MR0424806) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: WA OD00003743) |
| 152W00000X Optometrist (Licence: AK 226) | |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2008-08-14 |