| NPI | 1851488639 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: WA OD 0001073) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: WA OD 0001073) |
| 152WP0200X Optometrist, Pediatrics (Licence: WA OD 0001073) | |
| 152WS0006X Optometrist, Sports Vision (Licence: WA OD 0001073) | |
| 152WX0102X Optometrist, Occupational Vision (Licence: WA OD 0001073) | |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2009-08-14 |