| NPI | 1912721135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 156FX1800X Technician/Technologist Optician |
| Additional Taxonomies | 156FC0800X Technician/Technologist Contact Lens |
| 156FX1101X Technician/Technologist Ophthalmic Assistant | |
| 332H00000X Eyewear Supplier | |
| Enumeration Date | 2024-11-13 |
| Last Update Date | 2024-11-13 |