| NPI | 1689669624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 156FX1700X Technician/Technologist, Ocularist (Licence: OR 516802-89) |
| Additional Taxonomies | 1744P3200X Specialist, Prosthetics Case Management (Licence: OR 51680289) |
| Enumeration Date | 2005-09-15 |
| Last Update Date | 2011-08-24 |