| NPI | 1639247968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 156FX1700X Technician/Technologist, Ocularist |
| Additional Taxonomies | 335E00000X Prosthetic/Orthotic Supplier |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2013-07-10 |