| NPI | 1518346204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 156FX1800X Technician/Technologist, Optician (Licence: NY 008353) |
| Additional Taxonomies | 156FC0801X Technician/Technologist, Contact Lens Fitter (Licence: NY 008353) |
| Enumeration Date | 2015-05-27 |
| Last Update Date | 2015-05-27 |