| NPI | 1487793246 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 156FC0800X Technician/Technologist, Contact Lens (Licence: CT 001299) |
| Additional Taxonomies | 156FX1800X Technician/Technologist, Optician (Licence: CT 000818) |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2007-07-08 |