| NPI | 1568814267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 156FX1800X Technician/Technologist, Optician (Licence: PA 213274) |
| Additional Taxonomies | 156FC0800X Technician/Technologist, Contact Lens (Licence: PA 213274) |
| Enumeration Date | 2016-07-06 |
| Last Update Date | 2016-07-06 |