| NPI | 1194581801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 156FX1800X Technician/Technologist, Optician (Licence: CT 001738) |
| Additional Taxonomies | 156FX1800X Technician/Technologist, Optician (Licence: NY c005696-1) |
| 156FX1800X Technician/Technologist, Optician (Licence: MA 5969) | |
| Enumeration Date | 2024-02-21 |
| Last Update Date | 2024-02-28 |