| NPI | 1942252259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AL R-316-TA-C84) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: WA WA#000003641) |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2023-08-25 |