| NPI | 1639302441 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 156FX1800X Technician/Technologist, Optician (Licence: GA 2087) |
| Additional Taxonomies | 156FC0800X Technician/Technologist, Contact Lens (Licence: VA 143958) |
| 156FX1800X Technician/Technologist, Optician (Licence: NV 351) | |
| Enumeration Date | 2009-08-26 |
| Last Update Date | 2009-08-26 |