| NPI | 1659766004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: WA OD60670018) |
| Additional Taxonomies | 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: WA OD60670018) |
| 152WP0200X Optometrist, Pediatrics (Licence: WA OD60670018) | |
| 152WV0400X Optometrist, Vision Therapy (Licence: WA OD60670018) | |
| Enumeration Date | 2015-04-02 |
| Last Update Date | 2022-02-24 |