| NPI | 1780953406 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 156FX1800X Technician/Technologist, Optician (Licence: NC 1987) |
| Additional Taxonomies | 156FX1800X Technician/Technologist, Optician (Licence: NY 3776) |
| 156FX1800X Technician/Technologist, Optician (Licence: FL 1410) | |
| Enumeration Date | 2011-12-27 |
| Last Update Date | 2015-01-25 |