| NPI | 1194780361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: WA 60022188 OD) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: WV WV1020OD) |
| Enumeration Date | 2006-04-19 |
| Last Update Date | 2023-01-24 |