| NPI | 1649226374 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152WC0802X Optometrist, Corneal and Contact Management (Licence: WA OD00001475) |
| Additional Taxonomies | 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: WA OD00001475) |
| 152WP0200X Optometrist, Pediatrics (Licence: WA OD00001475) | |
| Enumeration Date | 2006-05-25 |
| Last Update Date | 2011-01-25 |