| NPI | 1750018461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: WA OD61440626) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: KY 2293DT) |
| Enumeration Date | 2022-08-03 |
| Last Update Date | 2024-03-29 |