| NPI | 1649505520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 156FX1800X Technician/Technologist, Optician (Licence: FL DO 3905) |
| Additional Taxonomies | 156FC0800X Technician/Technologist, Contact Lens (Licence: FL DO 3905) |
| 156FX1101X Technician/Technologist, Ophthalmic Assistant (Licence: FL DO 3905) | |
| 156FX1202X Technician/Technologist, Optometric Technician (Licence: FL DO 3905) | |
| Enumeration Date | 2009-10-09 |
| Last Update Date | 2013-12-19 |