| NPI | 1730381708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 156FX1800X Technician/Technologist Optician (Licence: FL DO5239) |
| Additional Taxonomies | 156FC0800X Technician/Technologist Contact Lens (Licence: FL DO5239) |
| Enumeration Date | 2007-06-01 |
| Last Update Date | 2020-09-24 |