| NPI | 1720179617 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 156FX1800X Technician/Technologist Optician (Licence: OH S488) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: OH 488S) |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2011-11-22 |