| NPI | 1790059160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 156FX1800X Technician/Technologist Optician (Licence: GA GA001342) |
| Additional Taxonomies | 156FC0800X Technician/Technologist Contact Lens (Licence: GA GA001342) |
| Enumeration Date | 2012-03-02 |
| Last Update Date | 2012-03-02 |