| NPI | 1174120083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 156FC0800X Technician/Technologist Contact Lens |
| Additional Taxonomies | 156FX1800X Technician/Technologist Optician |
| Enumeration Date | 2020-10-04 |
| Last Update Date | 2023-07-14 |