| NPI | 1306963889 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 156FC0801X Technician/Technologist Contact Lens Fitter (Licence: CA 930) |
| Additional Taxonomies | 156FX1800X Technician/Technologist Optician (Licence: CA D6907) |
| Enumeration Date | 2007-03-22 |
| Last Update Date | 2007-07-09 |