| NPI | 1811031610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 156FX1800X Technician/Technologist, Optician (Licence: CT 594) |
| Additional Taxonomies | 156FX1800X Technician/Technologist, Optician (Licence: MA 1270) |
| Enumeration Date | 2007-02-16 |
| Last Update Date | 2009-02-05 |