| NPI | 1568154771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 156FX1800X Technician/Technologist, Optician (Licence: TX 247662) |
| Additional Taxonomies | 156FC0801X Technician/Technologist, Contact Lens Fitter (Licence: TX 247662) |
| Enumeration Date | 2023-05-25 |
| Last Update Date | 2023-05-25 |