| NPI | 1932266558 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 156FX1800X Technician/Technologist Optician (Licence: CT 431) |
| Additional Taxonomies | 332H00000X Eyewear Supplier (Licence: CT L0431) |
| 332H00000X Eyewear Supplier (Licence: CT 1045) | |
| Enumeration Date | 2007-01-02 |
| Last Update Date | 2015-05-22 |