| NPI | 1275897910 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: WA 60351117) |
| Additional Taxonomies | 152WV0400X Optometrist, Vision Therapy (Licence: WA 60351117) |
| Enumeration Date | 2012-06-27 |
| Last Update Date | 2019-01-17 |