| NPI | 1477962660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 156FX1700X Technician/Technologist, Ocularist (Licence: AZ C001110) |
| Additional Taxonomies | 174400000X Specialist |
| Enumeration Date | 2014-08-13 |
| Last Update Date | 2022-08-13 |