| NPI | 1922233329 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 156F00000X Technician/Technologist (Licence: CT 1127) |
| Additional Taxonomies | 156FX1800X Technician/Technologist Optician (Licence: CT 1127) |
| Enumeration Date | 2009-05-29 |
| Last Update Date | 2009-05-29 |