| NPI | 1902983562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: WA 992) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: WA 992) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2007-07-13 |