| NPI | 1528365053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 156FC0801X Technician/Technologist, Contact Lens Fitter (Licence: MA 5128) |
| Additional Taxonomies | 156FC0800X Technician/Technologist, Contact Lens (Licence: MA 5128) |
| 156FX1700X Technician/Technologist, Ocularist (Licence: MA 5128) | |
| 156FX1800X Technician/Technologist, Optician (Licence: MA 5128) | |
| Enumeration Date | 2011-02-18 |
| Last Update Date | 2011-02-18 |