| NPI | 1598116063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 156FX1800X Technician/Technologist, Optician |
| Additional Taxonomies | 156F00000X Technician/Technologist |
| 156FC0800X Technician/Technologist, Contact Lens | |
| Enumeration Date | 2016-06-27 |
| Last Update Date | 2016-06-27 |