| NPI | 1992952048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: WA 60188658) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: HI 688) |
| Enumeration Date | 2008-08-20 |
| Last Update Date | 2016-01-29 |