| NPI | 1740389519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: WA OD00001416) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: WA 00001416) |
| 152WC0802X Optometrist, Corneal and Contact Management (Licence: WA OD00001416) | |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2021-09-16 |