| NPI | 1578394185 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 156FX1800X Technician/Technologist, Optician (Licence: FL D08056) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PR 2192-PA) |
| Enumeration Date | 2024-08-13 |
| Last Update Date | 2024-08-13 |