| NPI | 1487927406 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 156FC0801X Technician/Technologist Contact Lens Fitter (Licence: NY C004073-1) |
| Additional Taxonomies | 156FX1800X Technician/Technologist Optician (Licence: NY C004073-1) |
| Enumeration Date | 2012-02-22 |
| Last Update Date | 2019-01-24 |