| NPI | 1205511086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 156FX1800X Technician/Technologist, Optician (Licence: NJ 31td00104400) |
| Additional Taxonomies | 156FX1800X Technician/Technologist, Optician (Licence: 31td00104400) |
| Enumeration Date | 2023-06-19 |
| Last Update Date | 2023-06-19 |