| NPI | 1447916432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 156FX1800X Technician/Technologist Optician (Licence: 180344) |
| Additional Taxonomies | 332H00000X Eyewear Supplier (Licence: PA 180344) |
| Enumeration Date | 2021-11-13 |
| Last Update Date | 2021-11-13 |