| NPI | 1720330053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MT OPT-OPT-LIC-2475) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: WA OD 60576842) |
| Enumeration Date | 2012-10-10 |
| Last Update Date | 2023-02-15 |