| NPI | 1871808774 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: WA OD60518146) |
| Additional Taxonomies | 156FX1800X Technician/Technologist, Optician |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-08-16 |
| Last Update Date | 2015-11-10 |