| NPI | 1669291530 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 156FX1800X Technician/Technologist, Optician (Licence: NY c09275-1) |
| Additional Taxonomies | 156FX1800X Technician/Technologist, Optician (Licence: NY 9275-01) |
| Enumeration Date | 2024-10-08 |
| Last Update Date | 2024-10-08 |