| NPI | 1952407801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 156FC0800X Technician/Technologist Contact Lens |
| Additional Taxonomies | 156FC0801X Technician/Technologist Contact Lens Fitter |
| 156FX1700X Technician/Technologist Ocularist (Licence: TX N/A) | |
| 156FX1800X Technician/Technologist Optician (Licence: TX N/A) | |
| Enumeration Date | 2006-09-16 |
| Last Update Date | 2007-07-09 |