| NPI | 1841641719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152WP0200X Optometrist, Pediatrics (Licence: WA 60667755) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: WA OD60667755) |
| Enumeration Date | 2016-06-22 |
| Last Update Date | 2023-01-31 |