| NPI | 1265461594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: WA OD00003035TX) |
| Additional Taxonomies | 152WP0200X Optometrist, Pediatrics (Licence: WA OD00003035TX) |
| 152WS0006X Optometrist, Sports Vision (Licence: WA OD00003035TX) | |
| 152WV0400X Optometrist, Vision Therapy (Licence: WA OD00003035TX) | |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2008-05-21 |