| NPI | 1649260894 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 156FX1800X Technician/Technologist, Optician (Licence: FL DO4769) |
| Additional Taxonomies | 156FC0801X Technician/Technologist, Contact Lens Fitter (Licence: FL DO4769) |
| 156FX1101X Technician/Technologist, Ophthalmic Assistant (Licence: FL DO4769) | |
| Enumeration Date | 2005-10-27 |
| Last Update Date | 2022-07-21 |