| NPI | 1881929222 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: WA OD60098932) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CA OPT13858) |
| Enumeration Date | 2009-10-02 |
| Last Update Date | 2012-08-16 |