| NPI | 1740860147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: WA 61327713) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 152W00000X Optometrist (Licence: OR ATI4570) | |
| Enumeration Date | 2021-04-09 |
| Last Update Date | 2023-12-15 |