| NPI | 1043326572 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: WA OD 1647TX) |
| Additional Taxonomies | 152WC0802X Optometrist Corneal and Contact Management (Licence: OR 1764ATI) |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2007-07-08 |