| NPI | 1861708034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 156FX1800X Technician/Technologist, Optician (Licence: NE 033114) |
| Additional Taxonomies | 156FX1202X Technician/Technologist, Optometric Technician (Licence: NE 033114) |
| Enumeration Date | 2010-08-26 |
| Last Update Date | 2010-08-26 |