| NPI | 1104592930 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 156FX1800X Technician/Technologist Optician (Licence: MA MA5553) |
| Additional Taxonomies | 156FC0801X Technician/Technologist Contact Lens Fitter (Licence: MA MA5553) |
| Enumeration Date | 2021-08-20 |
| Last Update Date | 2021-08-20 |