| NPI | 1265799027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152WP0200X Optometrist, Pediatrics (Licence: WA OD60373317) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: WA OD60373317) |
| Enumeration Date | 2012-04-18 |
| Last Update Date | 2013-07-10 |