| NPI | 1003538737 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 156FX1800X Technician/Technologist, Optician (Licence: TX 192922) |
| Additional Taxonomies | 156F00000X Technician/Technologist |
| 156FX1100X Technician/Technologist, Ophthalmic | |
| 156FX1202X Technician/Technologist, Optometric Technician | |
| Enumeration Date | 2022-09-19 |
| Last Update Date | 2022-09-23 |