| NPI | 1942600648 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 156FX1800X Technician/Technologist Optician (Licence: MA 5269) |
| Additional Taxonomies | 156FC0801X Technician/Technologist Contact Lens Fitter (Licence: MA 5269) |
| Enumeration Date | 2014-08-29 |
| Last Update Date | 2014-08-29 |