| NPI | 1891175709 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 156FX1100X Technician/Technologist, Ophthalmic (Licence: WA DO 00000569) |
| Additional Taxonomies | 156FX1800X Technician/Technologist, Optician (Licence: WA DO 00000569) |
| Enumeration Date | 2015-06-05 |
| Last Update Date | 2015-06-05 |