| NPI | 1710048335 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 156FX1800X Technician/Technologist Optician (Licence: OR NOT APPLICABLE) |
| Additional Taxonomies | 156FX1800X Technician/Technologist Optician (Licence: OR NOT APPLICABLE) |
| Enumeration Date | 2006-12-13 |
| Last Update Date | 2008-06-09 |