| NPI | 1750987079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 156FX1800X Technician/Technologist Optician (Licence: OH OP.017156-S) |
| Additional Taxonomies | 332H00000X Eyewear Supplier |
| Enumeration Date | 2020-12-10 |
| Last Update Date | 2020-12-10 |