| NPI | 1508226762 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 156FX1800X Technician/Technologist Optician (Licence: CT 1629) |
| Additional Taxonomies | 156FX1800X Technician/Technologist Optician (Licence: MA 6151) |
| 156FX1800X Technician/Technologist Optician (Licence: RI OP0035) | |
| Enumeration Date | 2016-03-02 |
| Last Update Date | 2016-03-02 |