| NPI | 1528431707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 156FC0801X Technician/Technologist, Contact Lens Fitter (Licence: OH APP. 14766) |
| Additional Taxonomies | 156FX1800X Technician/Technologist, Optician (Licence: OH APP. 14766) |
| Enumeration Date | 2015-11-10 |
| Last Update Date | 2016-05-16 |