| NPI | 1427007152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: WA 3567TX) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: WA 3567TX) |
| 152WP0200X Optometrist, Pediatrics (Licence: WA 3567TX) | |
| 152WS0006X Optometrist, Sports Vision (Licence: WA 3567TX) | |
| Enumeration Date | 2006-05-09 |
| Last Update Date | 2017-10-19 |