| NPI | 1164590030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 237700000X Hearing Instrument Specialist (Licence: WA HA 00000679) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: WA 00001651) |
| Enumeration Date | 2006-11-30 |
| Last Update Date | 2023-12-22 |