| NPI | 1942534235 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: WA 60099363) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: ID ODP-100218) |
| Enumeration Date | 2009-09-20 |
| Last Update Date | 2013-09-23 |