| NPI | 1083036909 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 156FX1800X Technician/Technologist, Optician (Licence: AK 328) |
| Additional Taxonomies | 156FX1800X Technician/Technologist, Optician (Licence: FL 2147) |
| Enumeration Date | 2014-01-12 |
| Last Update Date | 2014-01-12 |