| NPI | 1780656660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: WA WA1115TX) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: WA WA1115TX) |
| 152WV0400X Optometrist, Vision Therapy (Licence: WA WA1115TX) | |
| Enumeration Date | 2006-02-03 |
| Last Update Date | 2018-07-31 |