| NPI | 1720786890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 156FX1800X Technician/Technologist, Optician |
| Additional Taxonomies | 156FX1800X Technician/Technologist, Optician |
| Enumeration Date | 2023-02-20 |
| Last Update Date | 2023-02-20 |