| NPI | 1154488427 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 156FC0800X Technician/Technologist Contact Lens (Licence: CA CL 70) |
| Additional Taxonomies | 156FX1800X Technician/Technologist Optician (Licence: CA D-602) |
| Enumeration Date | 2007-01-03 |
| Last Update Date | 2007-07-08 |