NPI | 1619007333 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 156FX1800X Technician/Technologist, Optician (Licence: MA 4043) |
Additional Taxonomies | 156FC0800X Technician/Technologist, Contact Lens (Licence: MA 4043) |
174400000X Specialist (Licence: MA 0034) | |
247200000X Technician, Other (Licence: MA 0034) | |
Enumeration Date | 2007-03-06 |
Last Update Date | 2012-11-01 |