| NPI | 1881738029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OK 2311) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: WA 3615) |
| Enumeration Date | 2007-02-19 |
| Last Update Date | 2009-08-27 |