| NPI | 1770603375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 156FC0800X Technician/Technologist Contact Lens (Licence: NY 3079) |
| Additional Taxonomies | 156FX1800X Technician/Technologist Optician (Licence: NY 3079) |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2007-07-08 |