| NPI | 1225147408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OR 1608 ATI) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: WA 1821) |
| 152WC0802X Optometrist Corneal and Contact Management (Licence: OR 1608 ATI) | |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2016-04-20 |