| 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 |