| NPI | 1235649955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 156FX1800X Technician/Technologist, Optician (Licence: MA 6100) |
| Additional Taxonomies | 171W00000X Contractor (Licence: MA 6100) |
| Enumeration Date | 2017-10-08 |
| Last Update Date | 2017-10-08 |