| NPI | 1306223201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 156FX1800X Technician/Technologist, Optician (Licence: SC 720) |
| Additional Taxonomies | 156FC0801X Technician/Technologist, Contact Lens Fitter (Licence: SC 217) |
| 156FX1800X Technician/Technologist, Optician (Licence: NC 1669) | |
| Enumeration Date | 2015-04-29 |
| Last Update Date | 2015-04-29 |