| NPI | 1760605034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 156FX1100X Technician/Technologist, Ophthalmic (Licence: NC 156FX1100X) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: NC 018088) |
| Enumeration Date | 2007-04-11 |
| Last Update Date | 2007-07-08 |