| NPI | 1336615764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 156FX1800X Technician/Technologist Optician (Licence: CT 1193) |
| Additional Taxonomies | 156FX1100X Technician/Technologist Ophthalmic (Licence: CT 1193) |
| Enumeration Date | 2018-10-24 |
| Last Update Date | 2018-10-24 |