| NPI | 1285721084 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 156FC0800X Technician/Technologist, Contact Lens (Licence: FL fl2364do) |
| Additional Taxonomies | 156FX1800X Technician/Technologist, Optician (Licence: FL fl2364do) |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2007-07-08 |