| NPI | 1811125164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 156FX1800X Technician/Technologist Optician (Licence: MA 5655) |
| Additional Taxonomies | 156FC0800X Technician/Technologist Contact Lens (Licence: MA 5655) |
| Enumeration Date | 2009-06-25 |
| Last Update Date | 2009-06-25 |