| NPI | 1235356908 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 156FX1800X Technician/Technologist Optician (Licence: RI OP 00334) |
| Additional Taxonomies | 156FX1800X Technician/Technologist Optician (Licence: MA 5703) |
| Enumeration Date | 2007-04-20 |
| Last Update Date | 2012-11-26 |