| NPI | 1659482685 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 156FX1800X Technician/Technologist, Optician (Licence: RI OP00075) |
| Additional Taxonomies | 156FX1800X Technician/Technologist, Optician (Licence: MA 1332) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2007-07-08 |