| NPI | 1184853343 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: WA OD60096389) |
| Additional Taxonomies | 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: WA OD60096389) |
| 152WX0102X Optometrist, Occupational Vision (Licence: WA OD60096389) | |
| 152WP0200X Optometrist, Pediatrics (Licence: WA OD60096389) | |
| 152WC0802X Optometrist, Corneal and Contact Management (Licence: WA OD60096389) | |
| Enumeration Date | 2009-07-09 |
| Last Update Date | 2016-12-29 |