| NPI | 1568936680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 156FX1700X Technician/Technologist, Ocularist (Licence: OH O.25) |
| Additional Taxonomies | 229N00000X Anaplastologist |
| Enumeration Date | 2019-01-11 |
| Last Update Date | 2021-09-16 |