| NPI | 1043362882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: WA OD00000787) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: WA MS1246897) |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2007-10-16 |