| NPI | 1902039159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 156FX1800X Technician/Technologist, Optician (Licence: NY c6690-1) |
| Additional Taxonomies | 156FC0801X Technician/Technologist, Contact Lens Fitter (Licence: NY c6690-1) |
| Enumeration Date | 2009-09-03 |
| Last Update Date | 2009-09-03 |