| NPI | 1154371037 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: WA OD00001355) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: WA OD00001355) |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2012-10-11 |