| NPI | 1316323470 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 156FC0800X Technician/Technologist Contact Lens |
| Additional Taxonomies | 156FC0801X Technician/Technologist Contact Lens Fitter |
| 156FX1800X Technician/Technologist Optician | |
| Enumeration Date | 2015-07-30 |
| Last Update Date | 2015-07-30 |