| NPI | 1275030025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 156FX1800X Technician/Technologist, Optician |
| Additional Taxonomies | 156FC0800X Technician/Technologist, Contact Lens |
| 332H00000X Eyewear Supplier (Equipment, not the service) | |
| Enumeration Date | 2018-04-09 |
| Last Update Date | 2024-06-12 |