| NPI | 1770338568 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 156FX1800X Technician/Technologist Optician (Licence: GA 1550) |
| Additional Taxonomies | 156FX1800X Technician/Technologist Optician (Licence: FL 6077) |
| Enumeration Date | 2024-04-23 |
| Last Update Date | 2024-04-23 |