| NPI | 1407502065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 246Z00000X Specialist/Technologist, Other |
| Additional Taxonomies | 156FX1202X Technician/Technologist, Optometric Technician |
| 156FX1100X Technician/Technologist, Ophthalmic | |
| 156FX1800X Technician/Technologist, Optician | |
| Enumeration Date | 2022-02-22 |
| Last Update Date | 2024-02-22 |