| NPI | 1891820411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: WA 2057) |
| Additional Taxonomies | 152WP0200X Optometrist, Pediatrics (Licence: WA 00002057) |
| Enumeration Date | 2007-02-22 |
| Last Update Date | 2015-05-14 |