| NPI | 1932472768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 156FX1800X Technician/Technologist, Optician (Licence: MD 36730) |
| Additional Taxonomies | 156FC0801X Technician/Technologist, Contact Lens Fitter (Licence: MD 075117) |
| Enumeration Date | 2012-02-09 |
| Last Update Date | 2012-02-09 |