| NPI | 1043278716 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 156FC0800X Technician/Technologist Contact Lens (Licence: SC 242) |
| Additional Taxonomies | 156FX1800X Technician/Technologist Optician (Licence: SC 776) |
| 156FX1800X Technician/Technologist Optician (Licence: OH 6004) | |
| 156FX1800X Technician/Technologist Optician (Licence: HI 260) | |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2007-07-09 |