| NPI | 1265546469 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 3747A0650X Technician, Attendant Care Provider |
| Additional Taxonomies | 152W00000X Optometrist (Licence: WA OD00001949) |
| 152W00000X Optometrist (Licence: OR 2061ATI) | |
| Enumeration Date | 2006-08-18 |
| Last Update Date | 2022-06-28 |