| NPI | 1265706998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 156FX1800X Technician/Technologist, Optician |
| Additional Taxonomies | 305R00000X Preferred Provider Organization |
| Enumeration Date | 2012-02-27 |
| Last Update Date | 2012-02-27 |