| NPI | 1699002345 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 156FX1100X Technician/Technologist Ophthalmic (Licence: NY COO5692) |
| Additional Taxonomies | 247200000X Technician, Other (Licence: NY COO5692) |
| 156FC0800X Technician/Technologist Contact Lens (Licence: NY COO5692) | |
| 156FC0801X Technician/Technologist Contact Lens Fitter (Licence: NY COO5692) | |
| 156FX1202X Technician/Technologist Optometric Technician (Licence: NY COO5692) | |
| Enumeration Date | 2009-11-17 |
| Last Update Date | 2009-11-19 |