| NPI | 1053423640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: WA 1267TX) |
| Additional Taxonomies | 152WC0802X Optometrist Corneal and Contact Management (Licence: WA 1267TX) |
| 152WL0500X Optometrist Low Vision Rehabilitation (Licence: WA 1267TX) | |
| 152WP0200X Optometrist Pediatrics (Licence: WA 1267TX) | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2009-01-28 |